Work with Us - Gosnells Smash Repairs

Title *

Name *

First

Last

Date of Birth (dd/mm/yyyy)

Gender

Address

Mobile *

Email *

Driver License No *

Class/s Held *

Education (Institution)

Year Completed

Tafe/Trade (Institution)

Year Completed

Other (Relevant to position)

Current/Recent Employer Name

Employer Address

Job Role

Time Held (Years)

Selected Value: 0

Duties

Additional Working History

1. Have you ever claimed workers compensation benefits?

If Yes please provide details of your injury, including date of injury & any current medical restrictions

2. Do you have any non-work related injuries, illnesses or disabilities that may impact on your physical and phychological fitness for this position?

If Yes please provide details of your condition, any limitations & medical restrictions

3. Do you require any physical modifications to your working environment, special equipment, or special items for this position?

If Yes please provide details