Employment application for mining industry placement || BYAC Contractors Form

APPLICANT DETAILS
Surname	A value is required. A value is required.
Given Names	A value is required.
Address - No & Street	A value is required.A value is required. A value is required.
Suburb/Town	A value is required. A value is required.
State	Please select a valid item. Please select an item.
Post Code	A value is required.
Telephone	A value is required.
Mobile Number
Email if available	Invalid format.
Date of Birth (dd/mm/yyyy)	A value is required.Invalid format. e.g. 02/10/1995
Do you hold a valid Driver's Licence?	YES NO Please choose onePlease choose only Yes or No
For safety and insurance reasons all mining companies require all minesite workers to hold a valid and current A Class Driver's Licence
Class(es) of Licence Held
State of Issue
Male Female Please make a selection. Please Choose onePlease choose only one	Aboriginal Non Aboriginal Please choose onePlease choose only one
Please Note: Due to mandatory procedures for working on mine sites, it is required that all minesite employees have a pre-employment medical, drug and alcohol test and a police clearance prior to mobilisation
Submit your CV if available
Use the Browse button to locate your CV or any document relevant to your application. The file you choose will be sent to BYAC when you complete and submit this application.

EDUCATION & TRAINING

Name the highest level of secondary school you attended including the year

List tertiary education courses undertaken (TAFE, University etc)

Provide details of any Qualifications, Trade Skills or Certificates you now hold (eg Forklift Operator, Rigger, Scaffolder, Crane Driver etc)

EMPLOYMENT HISTORY
1. Period of Employment	From	To
Employer's Name
Address
State
Post Code:
Supervisor's Name
Supervisor's Tel No:
Position Held
Still Employed	Yes No
Summary of Duties

2. Period of Employment	From	To
Employer's Name
Address
State
Post Code:
Supervisor's Name
Tel No:
Position Held
Still Employed	Yes No
Summary of Duties

3. Period of Employment	From	To
Employer's Name
Address
State
Post Code:
Supervisor's Name
Tel No:
Position Held
Still Employed	Yes No
Summary of Duties

WORKERS COMPENSATION CLAIMS
If you have claimed workers compensation in the last 5 years please provide details below
Name of Employer
Approximate Date
Nature of Claim (Provide a brief description of the work related injury)

Name of Employer
Approximate Date
Nature of Claim (Provide a brief description of the work related injury)

I declare that to the best of my knowledge the information I am submitting in this form is true and correct Please make a selection. Check box must be ticked for form to submit
		Top of Form

Clicking the "Submit-Post" button should submit your application and redirect you to a "Thank You" page. If this does not happen please check the form to make sure you have completed all REQUIRED flelds. If any required fields are left uncompleted they will be identified by Red captions adjacent to the field.

TRAINING & DEVELOPMENT
Please indicate those areas in which you may be interested in undertaking further training
Trades Apprenticeships - Traineeships		Plant Operator - Maintenance Skills
	Electrical Instrument Fitter		Rigger
	Boilermaker		Scaffolder
	Fitter		Dogman
	Diesel Mechanic		Crane Driver
	Machinist		Forklift Driver
			Truck Driver
			Elevator Platform (Cherry picker)
	Other (Please specify)		Skid Steer Loader (Bobcat)
			Front End Loader

HEALTH HISTORY
It is mandatory for all minesite workers, prior to mobilisation, to have a police clearance and a current pre-employment medical, drug and alcohol test from a registered authority
Do you hold a current First Aid Certificate?	Yes No Minimum number of selections not met.Maximum number of selections exceeded
Do you suffer now or have you suffered in the past from any of the following. Please mark all items
1. Blackouts	Yes No Minimum number of selections not met.Maximum number of selections exceeded	7. Lung Ailments	Yes No Minimum number of selections not met.Maximum number of selections exceeded
2. Skin Disorders	Yes No Minimum number of selections not met.Maximum number of selections exceeded	8. Physical Disability	Yes No Minimum number of selections not met.Maximum number of selections exceeded
3. Heart Problems	Yes No Minimum number of selections not met.Maximum number of selections exceeded	9. Allergies	Yes No Minimum number of selections not met.Maximum number of selections exceeded
4. Blood Pressure	Yes No Minimum number of selections not met.Maximum number of selections exceeded	10. Back Problems	Yes No Minimum number of selections not met.Maximum number of selections exceeded
5. Impaired Eyesight	Yes No Minimum number of selections not met.Maximum number of selections exceeded	11.Hearing Disability	Yes No Minimum number of selections not met.Maximum number of selections exceeded
6. Asthma	Yes No Minimum number of selections not met.Maximum number of selections exceeded
If you answered yes to any of these items please provide brief details below

To enable us to determine the category of work you are able to perform please indicate if you are able to work under any of the following conditions
Shift Work	Yes No	Alternative Sites	Yes No
Dusty Conditions	Yes No	Remote Sites	Yes No
Heights	Yes No	Camp Situations	Yes No
Manual Labour	Yes No	Service Own Machine	Yes No

Employment Application4

APPLICANT DETAILS

Surname

Given Names

Address - No & Street

Suburb/Town

State

Post Code

Telephone

Mobile Number

Email if available

Date of Birth (dd/mm/yyyy)

Do you hold a valid Driver's Licence?

Class(es) of Licence Held

State of Issue

Male Female Please make a selection.

Aboriginal Non Aboriginal Please choose onePlease choose only one

Submit your CV if available

EDUCATION & TRAINING

TRAINING & DEVELOPMENT

EMPLOYMENT HISTORY

HEALTH HISTORY

WORKERS COMPENSATION CLAIMS

You must be redirected to the "Thank You" page for the application to be submitted.