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Residency
Position applying for:
First name:
Surname:
Address:
Suburb:
State:
Postcode:
Home Phone:
Mobile:
Email:
Are you an Australian Citizen, Permanent Resident, Entitled to work by a work visa?*
Australian Citizen
Permanent Resident
Entitled to work by a Visa
* Please provide proof of your entitlement to work in Australia
Background Information
All employment applicants at Mai-Wel who pass the interview stage in the recruitment stage will have background screening checks completed. The background screening may include employment and personal reference checks, criminal history records check, Prohibited Employment Declaration and Working With Children check. No background checks can be completed on an applicant wihout consent being provided. (Note: the declaration and consent forms are to be completed and signed at the interview).

I consent to Mai-Wel contacting my referees:	Yes No
I am willing to undergo a working with children check:	Yes No
I am willing to undergo a criminal record check:	Yes No
I am willing to undergo a pre employment medical review:	Yes No
Do you have any convictions, finding of guilt and/or pending charges (non traffic) in either NSW, or any other state or territory of Australia or under Commonwealth law in any other jurisdiction?	Yes No

Pre Employment/Medical Information
Please provide any further details which may be relevant to the above questions:
Please complete the questions below, providing any further information as necessary. This will assist us to comply with our obligation to ensure a safe workplace and to enable us to determine whether applicants are able to safely and adequately perform duties required by the position.
Do you have any health issues or injuries, including any medical, physical or spychiatric conditions which could prevent you from carrying our the full range of duties as described in the recruitment process? Or by carrying out any of these duties could your health issues or injuries be adversely affected?
If Yes, please provide further details:
Have you ever had a worker's compensation claim in the past 10 years?
If Yes, please provide further details:
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Agreement
By submitting this application I declare that the above information is true and correct. I understand that if I have provided false or misleading information it may result in a decision to not employ me, or if already employed, may lead to dismissal.

Agreement

By submitting this application I declare that the above information is true and correct.

I understand that if I have provided false or misleading information it may result in a decision to not employ me, or if already employed, may lead to dismissal.