NUCREW

WARNING:

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

Find out how

REGISTRATION FORM – CONTRACTORS

Personal Information (You Must Complete All Sections To Submit Your Registration Form)

* First Name

* Last Name

* Email

* Date of Birth

Contact Number (Home)

* Contact Number (Mobile)

Do you identify as Aboriginal or Torres Strait Islander?

* Gender Identification

Home Address

* Street

* City

* State

* Postal Code

Emergency Contact Details

* Emergency Contact Name

* Emergency Contact Relationship to you

* Emergency Contact Phone

Driver’s Licence & Work Rights

* Do you hold a current driver’s licence?

* Licence Class

Expiry Date

* Do you currently hold valid work rights in Australia?

Criminal History Declaration

* Do you have any past, present, or pending criminal charges or convictions?

* if yes, please provide details

Health-Related Information

* Height

* Weight

* Are you currently taking any medications, either prescribed or over the counter?

* If yes, list the medication names, dosages, and frequency of use:

Medical Information (This Section Must Be Completed)

* Do you have any allergies or specific dietary requirements?

* If yes, please specify your needs:

* Is there any other relevant health or medical information that we should be aware of to ensure your health and safety and that of others in the workplace?

(Examples may include conditions such as high or low blood pressure, heart conditions, respiratory issues, back pain, epilepsy, etc.)

* If yes, please provide full details

* Could any medications you are taking (prescription or otherwise) impact your ability to perform your work, or produce side effects that may affect your job performance?

* If yes, provide details of how it may affect your work

* Are you currently under the care of a doctor for any medical conditions, or do you have any pending treatments or surgeries?

* If yes, please provide details of the condition or treatment

* Would you require any adjustments to be made to the workplace, the duties of your role, or the equipment provided, to accommodate a medical condition or disability?

* If yes, please detail the necessary accommodations

References

Referee 1

* Referee 1 Full Name

* Referee 1 Position Title

* Referee 1 Company

* Referee 1 Phone Number

Referee 2

* Referee 2 Full Name

* Referee 2 Position Title

* Referee 2 Company

* Referee 2 Phone Number

Employee Declaration

* I accept the Privacy Policy ?

* I declare that each and every answer that I provide within this application form is true and accurate to the best of my knowledge and understanding. I understand that any false or misleading information may result in the termination of my employment and/or refusal of any possible claim to compensation.