Employment Registration Form

Personal Details

* First Name

* Last Name

DOB

* Email

* Mobile

Address

* Suburb

* State

* Postcode

* Do you have a current Australian drivers Licence?

Yes

Drivers Licence Number

Class

Expiry Date

Height

Weight

Emergency Contact Details

* Emergency Contact Name

Relationship

* Contact Number 1

Contact Number 2

General Questions

Do you identify as an Aboriginal or Torres Strait Islander?

Yes

* Are you registered with a Job Service Provider (job prospects, Max Employment, Matchworks, and Workskil etc.)?

Yes

If yes how long have you been registered with this provider?

Job Seeker ID Number

IronMerge has a Workforce Participation/ Local Industry plan. The objective of this is to increase the employment and training of Apprentices & Trainees, Indigenous Australians, and Displaced Automotive Industry Workers & Local People with Barriers to Employment.

If this applies please tick the appropriate box:

Apprentice or Trainee

Cadet (University studies)

Indigenous Australian

Displaced Automotive Worker

Australian Worker Rights

* What are your current working rights?

* Can you provide a copy of your Passport, birth certificate or VISA information? - Essential to work for IronMerge as this is a statutory requirement.

Yes

Passport Upload

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Birth Certificate Upload

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VISA Upload

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***As you may be aware, it is an offence under the Migration Act 1958 for a person to knowingly or recklessly allow an illegal worker to work or refer an illegal worker for work with another business. By completing this form and signing this registration, it will be taken as your authorisation to use the information provided to check your eligibility to work with the Dept. of Immigration.

Criminal History - Disclosure Declaration

* Have you ever been convicted by a court or dismissed from employment for an offence involving drugs, dishonesty and breach of trust, sexual harassment, violence, or any other Criminal Offence?

Yes

If yes, please provide further details

* Do you have a National Police Clearance that is less than 12 months old?

Yes

National Police Clearance Upload

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Medical Details

Some jobs may require physical (such as lifting) and repetitive work, or expose you to hazards. IronMerge needs to be aware of any pre-existing conditions you may have that may render you unable to fulfill the requirements of the role. Medical information is not designed to exclude you from employment: however we have a duty of care to yourself and IronMerge to provide the right opportunities to enable you to perform your duties safely which do not hinder yourself or became a risk to yourself or others. All information provided will be stored and controlled in line with Privacy Legislation.

* Do you suffer from any allergies? (I.e. bee stings, food, latex, medications, cleaning agents)?

Yes

* Is the allergy life threatening?

Yes

* If YES, Do you carry an Epipen?

Yes

If yes, please provide further detail

* Are you currently on any medication(s) including inhalers?

Yes

If yes, please provide further detail

Have you ever been treated for, or suffer from, any of the following injuries / illnesses, broken bones, or conditions, now or in the past?

* Shoulder pain or Injury

Yes

* Neck pain or Whiplash

Yes

* Substance abuse

Yes

* Blurred vision

Yes

* Skin conditions

Yes

* Ear or Eye Problems

Yes

* Arm/Elbow Injury

Yes

* Migraines / Headaches

Yes

* Osteoarthritis / Arthritis

Yes

* Wrist/Hand Injury

Yes

* Dizziness / Fainting

Yes

* Blood borne diseases

Yes

* Hip / Leg Injury

Yes

* Sleep Apnea

Yes

* RSI / Carpal Tunnel

Yes

* Foot/Ankle injury

Yes

* Vertigo

Yes

* Hearing Difficulties

Yes

* Diabetes

Yes

* Colour Blindness

Yes

* Knee Pain or Injury

Yes

* Heart Condition

Yes

* Epilepsy / Fits

Yes

* Hernia / Abdominal Pain

Yes

* High Blood Pressure

Yes

* Anxiety / Stress / Depression

Yes

* Tennis Elbow

Yes

* Asthma / Hay fever

Yes

* Psychiatric / Mental Illness

Yes

* Chronic Fatigue

Yes

* Shortness of breath

Yes

* Tinnitus / Ringing in Ears

Yes

* Lower Back Pain or Injury

Yes

If yes to any of the above, please provide further details

Medical Details Concerning Risks at Work

* Do you have a physical or psychological condition that may affect your capacity to work?

Yes

* Do you or have you, had difficulties or pain associated with manual handling tasks involving lifting or carrying weights or body movements?

Yes

* Do you require any specialised PPE to perform work related tasks?

Yes

* Do you experience pain in any part of the body?

Yes

* I accept that I may be require to undertake random drug and alcohol tests

Yes

* I accept that under some circumstances I may have to undergo a pre-employment medical prior to job offer/placement with IronMerge People

Yes

Conclusion

* How did you hear about us?

If other, please advise where you hear about us

Please upload any relevant tickets or documents below

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Expiration Date

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Document Upload 3

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Expiration Date