Amalgam

REGISTRATION FORM

Before attending your interview with one of our consultants, please complete the following registration form.
This form should be completed in full, including references, skills sheet and full disclosure of the Safety, Health and Well-being Questionnaire.

Please note:
This form will time out if you don't make changes within 30 minutes.

If you have any questions, concerns or cannot complete the form for any reason,
Please call our office on (08) 9227 6225 during office hours (8am – 5pm AWST)

Thanks,
Amalgam Recruitment

PERSONAL INFORMATION

* First Name

* Last Name

* Date of Birth

* Email

* Mobile

* Street Address

* Suburb

* State

* Postal Code

* Country

* When are you available to commence work?

* Select your Working Rights

EMPLOYMENT HISTORY

* Have you ever worked with other Recruitment Agencies?

* If yes, Which client/site did you work at (if none, enter N/A):

Current / Most Recent Employment:

* #1 - Company Name

* Position Title

* Start Date

End Date

TICKETS AND LICENCES

* Select your Licence Type(s)

Select your Tickets

Upload Drivers Licence

Choose file

Upload White card

Choose file

Upload any site induction
(eg. Rio Tinto / BHP / FMG)

Choose file

Document Type

Upload bachelor / diploma /
certificate / trade cert(s)

Choose file

Document Type

Upload high-risk work licence

Choose file

Document Type

Upload up-to-date Resume

Choose file

Upload other relevant documents

Choose file

Document Type

Upload other relevant documents

Choose file

Document Type

SAFETY & WELL BEING QUESTIONNAIRE
Amalgam Recruitment takes its commitment to the safety, health, and well-being of its employees seriously. Amalgam Recruitment is committed to the idea that every worker should return home from work in the state that they arrived in - Injury-Free.
The following questions are asked to determine your suitability for the variety of roles Amalgam Recruitment has at its client sites. Every workplace is different and poses different hazards and risks. By providing us with information on your medical history, any accidents, or injuries you have sustained and details on your preferred work environment, it will assist us in reducing your exposure to these hazards and risks and keep you Injury-Free.

if the position you are applying for requires it, can you:

* pass a drug & alcohol test?

Yes

* Provide a Police Clearance?

Yes

* pass a pre-employment medical?

Yes

* Have you ever had an injury or condition that could be affected by the work you are applying for?

Yes

If yes, please provide details:

* Have you had any surgery, illnesses or conditions that could be affected by the work you are applying for?

Yes

If yes, please provide details:

* Are you currently receiving any treatment or medication for any condition that may be affected by the work you are applying for?

Yes

If yes, please provide details:

* Are you currently under any physical or mental restrictions that may be affected by the work you are applying for?

Yes

If yes, please provide details:

SAFETY & WELL BEING STATEMENT OF ACCEPTANCE
If the information you provide us is not true, we may not be able to ensure your safety at work.
I agree to answer these questions honestly and understand they are asked to reduce the likelihood of my exposure to risk and hazards on client sites and therefore are to assist in keeping me Injury-free. Additionally, providing false information may also affect my employment with Amalgam Recruitment.

* I understand and accept that the information provided below is given willingly to assist Amalgam Recruitment in finding me employment.

* To the best of my knowledge, the Safety & Well Being Questionnaire answers I have provided are true and correct.

EMERGENCY CONTACT DETAILS

* Emergency Contact Name

* Emergency Contact Phone

* Nature of Relationship?

REFERENCES

* Reference 1: Full Name

* Reference 1: Company

* Reference 1: Phone/Mobile

Reference 2: Full Name

Reference 2: Company

Reference 2: Phone/Mobile

* I declare that the information I have provided to Amalgam Recruitment is true and correct. I understand that any offer of employment made by Amalgam Recruitment will be subject to the Terms and Conditions of employment as detailed below and agree to abide by Amalgam Recruitment or its customers’ rules, medical requirements, safety regulations, times of attendances at work etc, and any other conditions currently established on the work site designated for my employment assignment or issued from time to time.

* By continuing you agree to our Privacy Policy