Fusion5

⏱ PLEASE NOTE - This form has a 2-hour time limit before it expires and we recommend using Chrome. You will receive an email to confirm your email address once you submit this form. Please check your emails and confirm!

Personal Details (as per passport)

* First Name

* Last Name

Preferred Name

* Email

* Mobile

* Available Start Date (Notice Period)

* Full Street Address

* Suburb

* State/City

* Postal Code

* Country

Referee Details

Please note that if you are through a recruitment agency, you do not need to fill out your referee details. Please leave this section blank. For those who applied directly with Fusion5, feel free to leave this section blank and we will request referee details at a later date, if required.

Referee 1 Please provide following information below: Referee Name Company/Role/Relationship Phone Number Email Address

Referee 2 Please provide following information below: Referee Name Company/Role/Relationship Phone Number Email Address

Referee 3 Please provide following information below: Referee Name Company/Role/Relationship Phone Number Email Address

Eligibility to Work

* Do you currently hold any form of Visa ie; work, partner, post study, regional etc

Yes

If you do not hold citizenship of the country you are applying to work in, please provide:

A copy of your visa

Choose file

Expiration Date

Please state the type of visa

Do you require work visa sponsorship?

Yes

Visa

Choose file

Police Check

It is a requirement of all roles in Fusion5 that applicants undergo a police check, due to the handling on client information and data. Employment is conditional upon the assessment of the results of the police vetting being satisfactory.

* Do you have any criminal convictions or charges pending which might in any way impinge on your employment with Fusion5?

Yes

If you are in doubt as to the relevance to Fusion5 you should disclose the convictions and leave it to Fusion5 to decide. Of relevance to Fusion5 would be convictions involving public disorder, violence, fraud, dishonesty and for breaches of any legislation related to Fusion5’s activities, for example Fair Trading Act, Commerce Act, Securities Act, Companies Act, Insolvency Act etc. Please provide details below of any criminal convictions/charges pending:

* Do you consent to undergo a Police Check?

Yes

Proof of Identity

Please provide two (2) forms of identification

1) Passport OR Birth Certificate

Choose file

2) Drivers License OR Government-Issued ID

Choose file

Health

Please note that in the event you are employed by Fusion5 as a condition of your employment you may be required to provide relevant health information. Failure to disclose any pre-existing conditions or illnesses which could affect your performance in the role may impact your ongoing employment.

* Do you have any medical conditions which Fusion5 needs to be aware of in the event of an emergency where medical assistance may be required

Yes

If yes, please provide details below of condition below and medical assistance required:

* Do you have any injuries/pre-existing conditions that Fusion5 needs to be aware of where tasks required of this position may aggravate or affect your ability to perform the role? ie; tendonitis, back injury, OOS/RSI etc (this is to ensure you have the correct workstation set up)

Yes

If yes, please provide details below of allowances that need to be made:

Professional Integrity

Please indicate by ticking the appropriate box

* Have you been subject to any dispute or litigation involving previous employers?

Yes

* Are you aware of any information which may or may not have reached the public arena which would be relevant to your acceptability to clients of Fusion5 which might arise from your potential access to their confidential financial information?

Yes

Post-employment Restrictions

* If the previous employer is of the opinion, they are a “competitor to Fusion5” (regardless if Fusion5 agrees) please disclose all post-employment restrictions placed upon you by your current and/or former employer.

* Full Name/Signature:

* Date

* I declare that the information I have given in this application form is correct. I understand that if any false or misleading information is given it may lead to the termination of any employment that may be subsequently offered to me.