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Application for Emploment
Step
1
of
4
25%
Position
(Required)
Position hours
(Required)
Full time
Part time
Casual work
Any of these
Personal Details
Name
(Required)
First
Last
Email
Phone
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Date of Birth
(Required)
DD slash MM slash YYYY
GENERAL DETAILS
Licence No:
(Required)
Class:
(Required)
Expiry Date:
(Required)
DD slash MM slash YYYY
Number of Years Driving Experience:
(Required)
Types of Vehicles You Hold a Licence for:
(Required)
Do You have B-Double & Road Train Experience?
(Required)
Yes
No
Do you have Basic Fatigue Management?
(Required)
Yes
No
Training Courses Attended:
(Required)
List Vehicle Accidents in the Last Five (5) Years:
(Required)
Are you a Financial Member of the Transport Workers Union?
(Required)
Yes
No
If yes, please give details:
List Points Lost & Dates:
Have you ever been convicted of a criminal offence?
PERSONAL HISTORY
List last School Attended:
(Required)
Standard Achieved:
(Required)
Certificates held (Numbers & Expiry Dates):
(Required)
Please list your last three (3) employers
Present/Last Employer:
Present/Last Employer - Employed from:
DD slash MM slash YYYY
Present/Last Employer - To:
DD slash MM slash YYYY
Present/Last Employer - Address:
Present/Last Employer - Telephone:
Present/Last Employer - Position Held:
Present/Last Employer - Reason for Leaving:
Second Last Employer:
Second Last Employer - Employed from:
DD slash MM slash YYYY
Second Last Employer - To:
DD slash MM slash YYYY
Second Last Employer - Address:
Second Last Employer - Telephone:
Second Last Employer - Position Held:
Second Last Employer - Reason for Leaving:
Third Last Employer:
Third Last Employer - Employed from:
DD slash MM slash YYYY
Third Last Employer - To:
DD slash MM slash YYYY
Third Last Employer - Address:
Third Last Employer - Telephone:
Third Last Employer - Position Held:
Third Last Employer - Reason for Leaving:
MEDICAL HISTORY
IMPORTANT
: Failure to disclose a pre-existing Medical condition may result in immediate action upon discovery.
What is your general state of health?
(Required)
Please give details of previous Worker’s Compensation Claims:
Are you currently receiving any Worker’s Compensation?
(Required)
Yes
No
If yes, Please specify:
Do you have any claims pending against former employers pursuant to the Worker’s Compensation Act 1988 as amended?
(Required)
Yes
No
If yes, Please specify:
Do you experience or have you experienced any of the following conditions of ill health?
Visual Defects
Blackouts
Break Down
Diabetes
Rheumatic Fever
Kidney Disease
Lumbago
Mental Disorders
Loss of Hearing
Epilepsy
Gastric Ulcer
Allergies
Any Condition which limits Bending or Lifting
Speech Defects
Sinusitis
Duodenal Ulcer
Blood Pressure
Eczema
Hernia
Spinal Injuries
Head Injuries
Asthma
Abdominal Trouble
Nervous Disorders
Arthritis
Any Respiratory Breakdown
Insomnia / Sleep Apnoea / Micro-sleep
Other, please specify:
Contact Previous Employer - Consent
By ticking the box, I give permission for Wynyard Transport to contact my previous employees as identified in this application form.
Declaration of Applicant.
(Required)
By Ticking this box;
I declare that the answers to the foregoing questions are to the best of my knowledge true and correct in every particular.
That if my application for employment is successful I will be bound by and at all times observe and respect such terms and conditions of employment and such policies and rules as may from time to time be promulgated, specified or others stipulated by my employer. That I understand that any false declaration made by me in this application subjects me to instant dismissal.
Declaration - Name of Applicant
(Required)
First
Last
Declaration - Date
(Required)
MM slash DD slash YYYY