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Employment Form

* Required

Step 1 - Position/Personal Information
Position * Clerical Finance Mechanic Plant Operator Truck Driver - Agitator Truck Driver
First Name *	Last Name *
Address *
City *	State *
Postcode *	Country *
Phone Number *	Mobile Number *
Email Address *	I confirm that I am at least 18 years old? *
Do you hold a valid driver's licence? * Yes No	Do You require glasses for driving? * Yes No
Licence Number	State licence was issued in
Class of licence held H HR HC Car
Years (H) licence held for
Years (HR) licence held for
Years (HC) licence held for
Years (Car) licence held for
Licence Restrictions
Within the last five (5) years has your licence been suspended or revoked? Yes No
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Step 2.A - To be completed for all plant/mechanic/truck positions.
Current Licences/Permits Held (e.g Workcover/First Aid etc.) Please Start each Licence/Permit on a new line and include the Name, Class, State Obtained and Years Held for each Licence/Permit.
Skills Backhoe Excavator Forklift Grader Loader Other
Other Skills
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Step 2.B - To be completed for all clerical positions.
Qualifications Please start each qualification on a new line and include the name of the qualification, where it was obtained (Tafe/Uni/Other etc) and the date which it was obtained.
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Step 3 - Additional Information
Hobbies/Activities Please list sports or physical activities that you participate in.
Have you ever had a Workers Compensation Claim? * Yes No
Have you ever pleaded guilty to, or no contest to, or been convicted of a crime? * Yes No
Have you ever been asked to resign from a place of employment? * Yes No
Do you have any past or current injury / illness / physical reason that would limit or stop you carrying out any tasks while performing the job you have applied for? * Yes No
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Step 4 - Work History
Company Name and Address
Supervisor's Name and Contact Number
Position Held and Description of Work
Employment Date From: To:
Reason For Leaving

Company Name and Address
Supervisor's Name and Contact Number
Position Held and Description of Work
Employment Date From: To:
Reason For Leaving

Company Name and Address
Supervisor's Name and Contact Number
Position Held and Description of Work
Employment Date From: To:
Work History 3 - Reason For Leaving
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Step 5 - Consent
Upload a Copy Of Your CV (100Mb Limit *)
What is the earliest date you are available to commence working? *
Applications Received All applications received will be held confidentially on file for six (6) months from the date of receipt. After that time your application will be shredded. Consent I certify that the information provided in this application and in any attached pages is accurate and truthful. I consent to Tegra verifying all information provided herein. Verifications may include obtaining information from third parties, previous employers or supervisors and criminal conviction record check. I hereby release Tegra from any claims or causes of action that I may now or hereafter have, including, but not limited to, claims based on privacy, confidentiality or defamation as a result of its verification of any information contained herein or submitted herewith. I agree to the above statements *
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Step 6 - Review & Submit
Enter Word Verification in box below *