Amulet Security

Download Application Form

EMPLOYMENT APPLICATION

Full Name:

Address:

Phone:

Email Address:

Date of Birth:

Are you prepared to work a flexible or rotating roster that may incorporate?	Day	Yes No
	Afternoon	Yes No
	Night	Yes No
	Weekends	Yes No
	Public Holidays	Yes No

Can you provide a Tax File number

Yes No

Position applied for:

EDUCATION QUALIFICATIONS

Institution:		City/Country:
Qualifications:		Completed:

Institution:		City/Country:
Qualifications:		Completed:

Institution:		City/Country:
Qualifications:		Completed:

EMPLOYMENT HISTORY

Company Name:		Position Title :
Company Address:
Start Date:		End Date:
Responsibilities/ Achievements:
Reason for leaving

Company Name:		Position Title :
Company Address:
Start Date:		End Date:
Responsibilities/ Achievements:
Reason for leaving

Company Name:		Position Title :
Company Address:
Start Date:		End Date:
Responsibilities/ Achievements:
Reason for leaving

REFEREES

Contact Name:		Company Address:
Company Name:		Phone Number:

Contact Name:		Company Address:
Company Name:		Phone Number:

Contact Name:		Company Address:
Company Name:		Phone Number:

MEDICAL

To assist Amulet Security to fulfill its obligations under Occupational Health & Safety Laws, please disclose any information about injury or medical conditions you may have.

That May:

Prevent you from performing the inherent requirements of the position that you are applying for;
or May pose a risk to the health and safety of yourself, fellow employees or clients.

Do you suffer any illness that your employer should be aware of for your own protection? eg. Epilepsy, diabetes, asthma?	No (Next Question) Yes Please give full details
Are you aware of any physical or mental condition likely to affect the full performance of your duties in employment?	No (Next Question) Yes Please give full details
Have you ever made any Workers Compensation Claim?	No (Next Question) Yes Please give full details
Are you prepared to attend an examination if required?	Yes No

GENERAL

Current Security License Number	Expiry Date
Current Drivers License Number	Expiry Date
Current First Aid Certificate Number	Expiry Date
National Police Clearance (less than 3 months old)	Yes	No

Do you have any objections to enquiries made to your present employer, regarding qualifications and character?	No (Next Question) Yes Please give full details
Do you have any objections to us seeking verification and additional information to any matter within this application?	No (Next Question) Yes Please give full details
Is there any additional information you wish to give in support of your application?