HaloCivil

WARNING:

JavaScript is required to view this form. Please enable it in your browser settings.

Find out how

Expression of Interest

Resume

Choose file

Personal Details

* First Name

* Last Name

Contact Date of Birth

Gender

Mobile

* Email

Do you hold a current valid driver's license?

Residential Details

Street

City

State

Postal Code

Working Rights

Australian Citizen

Residential Status

Emergency Contact Details

Emergency Contact Name

Relationship to you

Emergency Contact Phone

Emergency Contact Address

Medical Questionnaire

Height (cm)

Weight (kg)

Known Allergies

Shirt Size

Are you currently taking medication (prescription or non-prescription) other than contraceptive medication, where applicable?

List all medications

Do you have any pre-existing medical conditions?

Please specify what kind of medical condition you have

Is there any other known condition/s including mobility or musculoskeletal issues which may impact upon your ability to perform the job safely?

If yes, provide details including date, nature of condition, period of incapacity, current status

Do you have an existing injury, condition or pre-existing injury or condition that could be affected by the nature of the proposed employment?

Please select if you have previously had or presently have any of the following:

If yes, provide date, nature of condition and how it is managed

Have you been hospitalized in the last 12 months?

Do you smoke/vape?

MEDICAL DECLARATION

Certain Prescription and Non-Prescription Medications may compromise the ability of the individual to safely perform their role. In accordance with Halo's Fitness for Work, all personnel or subcontractors are required to complete and provide a record of any prescription or non-prescription medications/s which may impact upon the performance of duties and/or is relevant should you require first aid or emergency care. Each state and territory has its own workers’ compensation scheme which may give an arbitrator discretion to refuse to award compensation which would otherwise be payable when it is proved that the worker has, at the time of seeking or entering employment in respect of which an individual claims compensation for an injury, wilfully and falsely represented himself as not having previously suffered from the injury. You are required to advise HALO CIVIL Limited of any pre-existing medical condition or claim.
DECLARATION
I sincerely declare that the contents of this form are true and correct and complete to the best of my knowledge and no information concerning my past or present state of health has been withheld. I hereby agree to undergo a health assessment by a medical practitioner if deemed necessary. I understand that any wilfully incorrect or misleading answer or material omission which relates to any of the questions before mentioned may make me ineligible for employment, or if employed, liable to disciplinary action which may include dismissal. I understand that this pre-employment health declaration may form part of my file.
AUTHORISATION:
I hereby authorise Halo Civil Engineering to release a copy of this record to relevant care providers upon request in the event of my requiring first-aid or emergency care.

* Acceptance of Declaration and Authorisation as stated above

* Date