Template – Job application form POSITION APPLIED FOR PERSONAL DETAILS Surname Given name Preferred name Address Work phone Home phone Mobile phone Email CURRENT QUALIFICATIONS Qualification title Institution/Training provider Year completed Are you currently undertaking study/training? (tick one) Yes No Course/program name Full-time Part-time Distance Other PREVIOUS EMPLOYMENT (MOST RECENT FIRST PLEASE) Employer name/establishment Dates from/to Position held Reason for leaving Office use check Initial/date REFERENCES Do you agree to have referees contacted in relation to this application? (tick one) Yes No (Reference checks will be conducted legally in an ethical manner and all information derived will remain confidential.) Please provide details of three people who can speak on your behalf regarding your work history. Name Contact number Position held/working relationship (for example, supervisor) Office use check Initial/date What type of work are you available for? (tick one) Full-time Part-time Casual 40 BETTER WORKPLACES – EMPLOYER RESOURCE KIT ATTRACT, RECRUIT AND SELECT www.businesspoint.tas.gov.au ATTRACT, RECRUIT AND SELECT OTHER INFORMATION When will you be available to start work? Please provide any other information that you identify as being pertinent to this application? (for example, medical conditions, disabilities) DECLARATION I declare that to the best of my knowledge the information given is true and correct. I understand that inaccurate, misleading or untrue statements or knowingly withheld information may result in termination of employment with this organisation. I understand that this application does not constitute an offer of employment. I understand that, in some cases, police and credit checks will be required and I will be notified if this applies to this application. Signed Date CONFIDENTIAL For Office Use Only REFERENCE CHECKS Reference name Comments Would re-employ? Yes No Initial Dat