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Candidate Registration Form

Personal Information

* First Name

* Last Name

Preferred Name

* Date of Birth

* Email

* Mobile

* Do you identify as an Indigenous Australian?

Date Available

Are you currently employed?

If working, what work type?

Current Employer

Current Position

If working, what is your notice period?

* Ideal Position

* Source

* Resume

Choose file

Cover Letter

Choose file

Drivers License

Choose file

Profile Picture

Choose file

What is your preferred roster?

Do you have any leave booked in the next 3 months? If so, when and how long?

Health Status Disclosure

Guma-Warnii is committed to providing a safe workplace to all its employees at all sites. In order to meet this commitment, Guma-Warnii needs to ensure that all its employees are working in a manner that maintains their employees’ health. As part of their terms of employment, Guma-Warnii requires all their employees to undergo regular medical checks and to report any injuries suffered whilst in the workplace. Guma-Warnii requires all candidates, as part of their application to disclose any existing medical conditions or medical conditions by for which the candidate has sought treatment from a general practitioner, allied health professional (physiotherapist, psychologist, occupational therapist) in the past 12 months that may now or if it recurs, affect the candidate ability to complete the normal duties and inherent requirements of the position for which the candidate has applied (or is applying for). This disclosure is essential to enable Guma-Warnii to meet its commitment to a safe workplace and necessary to determine that the candidate is not at risk of aggravating a pre-existing medical condition and can carry out the duties and inherent requirements of the position. This disclosure is treated as a confidential document and access is limited to a ‘need to know’ basis. In the event of the candidate being employed Guma-Warnii will retain this form on a confidential file and reserve the right to refer to the information in the event of an accident, sickness, injury or claim for worker’s compensation. The information may also be used for other purposes if so required by law.

Health and Safety

* Are you currently taking any medications?

If yes, please specify

* Are you currently, or in the past 6 months, received treatment of any kind?

If yes, please specify.

Have you:

* Been off work for longer than 1 month for an injury?

If yes, please specify

* Had a medical in the last 6 months and been refused employment?

If yes, please specify

Do you have difficulty with any of the below?

* Wearing PPE (helmet, safety glasses, steel cap boots)?

* Getting in and out of Vehicles on rough ground?

General Health Information

What is your height in cm?

If you are a mobile plant operator; the safety seat weight limit is 120kg; please state your weight

What is the general state of your health?

Do you have any restrictions that would stop you from doing your job correctly?

Do you engage in regular exercise?

Declaration

I, have read the Health Status Disclosure above and understand the purpose and uses that may be made of the information I have disclosed to Guma-Warnii. I have disclosed to Guma-Warnii any current medical condition or any medical condition for which I have sought treatment in the last 12 months that may now or if it recurs, affect my ability to complete my normal duties as an employee of Guma-Warnii and the inherent requirements of the position for which I have applied (or am applying). To the best of my knowledge I am able to fulfil the inherent requirements of the position. I acknowledge that if I have not disclosed that medical condition, Guma-Warnii cannot take that medical condition into account in providing me with a safe workplace and I understand that incorrect or misleading statements or omissions may render me liable for termination of employment or for disciplinary action and or negate any future claim for compensable injury or illness. If my application is successful, and information disclosed in this registration form is required to be made known to a supervisor or manager (or other authorised person and medical advisors) for the purposes of ensuring the safety and health of me or others in the workplace, I grant permission for such disclosure to be made.

* I declare that these details are true and correct.

* I acknowledge that any misrepresentation of facts is sufficient for legal action.

Thank you for your interest in working with us, we will review your application, and if we have a suitable role for you, a Consultant will be in touch.