MP Recruitment

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Registration Form

Please fill out the following form as required. Note that all information given will be kept confidential.

Personal Details

* First Name

* Last Name

* Email

* Mobile

Date of Birth

* Emergency Contact Name

* Emergency Contact Phone

Residential Details

Address

Suburb

State

Postal Code

* Do you Smoke/ Vape?

Country of Birth

* Australian Citizen?

* Do you identify as being Aboriginal or Torres Strait Islander?

VISA Status (if applicable)

* Own Transport

* Licences (Please tick all that apply)

Forklift operating

Food Handling

Food Safety

Do you have a Services Australia (Centrelink) employment services provider?

Health

MP Recruitment has a duty of care to our contractors to ensure so far as practicable we place you in areas that are safe and do not involve risk to your health or others while at work. We need to ensure that you are capable of performing the tasks associated with any assignment in which we place you.

* Do you suffer from any allergies?

* Do you have any medical conditions that may affect the health and safety, yourself or others?

Details:

Do you suffer from or experience any of these conditions or have you ever had difficulties with the following?

If you ticked any of the above boxes, please provide details.

* Do you have any existing injuries, diseases or medical conditions that could be affected by manual handling tasks?

Details

Do you suffer from any allergic reaction to certain chemicals?

DETAILS

* As you may be required to wear personal protective equipment, do you have any special requirements?

DEtails

Please provide details of any previous injuries or conditions which may be affected by your work.

* Do you or are you required to take drugs or medication that may affect your ability to perform any task?

Drug name and reason:

* Do you object to any alcohol/drug tests that may need to be undertaken in this employment process?

Please provide name and date in the box below to acknowledge the following declaration: I hereby certify that, to the best of my knowledge, the answers given above are correct. I understand that if I supply false or misleading information in my application I will, if subsequently employed, be liable to dismissal without notice.

* Full Name

* Date