Prime Recruitment

Candidate Registration & Medical Form

Personal Information

Salutation

* First Name

* Last Name

* Mobile

Alternative Number

* Email

* Date of Birth

* Street Address

* City

* State

* Postal Code

* Country

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

Employment Information

* Are you an Australia citizen?

Yes

Current Work Type

Current Position

Current Employer

Ideal Work Type

* Are you currently registered with a Workforce Australia provider?

Yes

If Yes - Provider Name and Provider Site / Location

How did you find out about us?

Document Upload Section

Resume

Choose file

Passport / Birth certificate / Citizenship

Choose file

Visa

Choose file

Expiration Date

Drivers License or Official photo ID with proof of address

Choose file

Expiration Date

First aid certificate

Choose file

Expiration Date

Working with children

Choose file

Expiration Date

Tickets

Confined Space Ticket

Choose file

Expiration Date

Crane

Choose file

Expiration Date

Dogging

Choose file

Expiration Date

EWP

Choose file

Expiration Date

Forklift LO/LF

Choose file

Expiration Date

Gas Test Atmospheres

Choose file

Expiration Date

Heavy Combination (HC)

Choose file

Expiration Date

Heavy Rigid (HR)

Choose file

Expiration Date

Light Rigid (LR)

Choose file

Expiration Date

Manual Handling

Choose file

Expiration Date

Medium Rigid (MR)

Choose file

Expiration Date

MSIC

Choose file

Expiration Date

NAC Card

Choose file

Expiration Date

Rigging (RB, RI, RA)

Choose file

Expiration Date

Scaffold (SB, SI, SA)

Choose file

Expiration Date

Traffic Control

Choose file

Expiration Date

Welder

Choose file

Expiration Date

White Card/Blue Card

Choose file

Expiration Date

Working At Heights

Choose file

Expiration Date

Other - Please specify in the file name

Choose file

Expiration Date

Medical Information

* Height (CM)

* Weight (KG)

General Information

* Have you ever had a work related injury?

Yes

* Have you ever had a sporting injury?

Yes

* Are you currently being treated by a doctor?

Yes

* Have you ever been hospitalised for any illness or had any operations?

Yes

* Extended work off in the last year beyond 4 weeks?

Yes

* Are you taking any medication?

Yes

* Is there any family history of medical conditions?

Yes

* Do you wear glasses or normal work?

Yes

* If so do you have prescription safety glasses?

Yes

If yes, please detail (1)

Do you have any difficulties with the following activities?

* Running 100 Meters

Yes

* Walking on rough ground

Yes

* Turning your head rapidly

Yes

* Using hand tools

Yes

* Concentrating for any length of time

Yes

* Hearing a normal conversation

Yes

* Reading ordinary print

Yes

* Climbing a ladder

Yes

* Crouching

Yes

* Lifting or bending

Yes

* Gripping firmly with both hand

Yes

* Repetitive movement of the arms

Yes

* Repetitive movement of the head

Yes

* Understanding English

Yes

If yes, please detail (2)

Do you have or have you had any of the following?

* Lung problems/asthma/bronchitis

Yes

* Suffered blood pressure or heart problems

Yes

* Joint problems/fractures or arthritis/rheumatism

Yes

* Repetitive strain/overruns

Yes

* Mental or nervous problems

Yes

* Blackout or persistent headaches

Yes

* Stomach problems/ulcers

Yes

* Loss of hearing/ear infections

Yes

* Fits or seizures

Yes

* A hernia

Yes

* Diabetes

Yes

* Allergies

Yes

* Hepatitis/Jaundice/Liver Trouble

Yes

* Tuberculosis

Yes

If yes to any of the above, please detail each one

Confirmation of Information

* All the information I have given in the Medical Information is true and accurate.

Declaration

* -MANDATORY- By clicking here I declare the information supplied by me is true, accurate and complete in all respects. I understand that if I withhold relevant information or supply false or misleading information about me, my application may not be further considered. I also understand that my employment or contract position may be terminated if, after investigation, an employer or client discovers that any information that I Label Value Maps to have provided is false or misleading. For further information on Prime Recruitment, please click here.

* I have read and acknowledge the Alcohol and Drugs Policy

* I have read and acknowledge the Anti Bribery and Corruption Policy

* I have read and acknowledge the Employee Industrial Relations Policy

* I have read and acknowledge the Equal Employment Opportunities Policy

* I have read and acknowledge the Health Safety and Environment Policy

* I have read and acknowledge the Injury Management Policy

* I have read and acknowledge the Medical Policy

* I have read and acknowledge the Personal Protective Equipment Policy

* I have read and accept the Employment Agreement