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Job Application Form

CONTACT INFORMATION

First Name *

Last Name

Date Of Birth *

Street Number and Name *

Suburbs

State/Province

ZIP / Postal Code

Mobile Number *

Email Address *

RESIDENCY

Are you an Australian resident? *YesNo

VISA Type

VISA Number

Are you of Aboriginal or Torres Strait Islander origin? *YesNo

DRIVER'S LICENCE

Licence Class *

Licence No *

State of Issue *

Licence Expiry Date *

Licence Image *

No file chosen

Auto or Manual? *AutoManualBothNone

Do you have a reliable vehicle to get to site? *YesNo

Are you confident in using a smartphone device? *YesNo

EMERGENCY CONTACT DETAILS

Contact Name *

Contact Phone *

Relationship *

POSITION

What position are you applying for? *

LOCATION

Which location are you applying for? *TL NewcastleTL SydneyTL WollongongTL Elite

EXPERIENCE

Years in industry *

EXPERIENCE IN INDUSTRYTraffic ControllerTeam LeaderSite SetupMotorwaysSuburban StreetsMajor RoadsDrawing TCPsConstruction SitesTMA Driving

QUALIFICATIONS/TICKETS

TRAFFIC CONTROL LICENCES HELDNSW General Construction Induction CardTraffic Controller & Implement Traffic Control Plans CardMotorwaysWorkers on Foot CardRIIRTM301D - Operate a Truck or Trailer Mounted AttenuatorOther

INDUCTIONS

INDUCTIONS HELDDownerSydney WaterM1M4M5M7BoralOther

EMPLOYMENT 1

Company Name *

Position Title *

Start Date *

End Date *

Duties Performed *

Reason for Leaving *

Reference Contact Name *

Referee Contact Phone *

Reference Contact Name

Reference Contact Phone

EMPLOYMENT 2

Company Name *

Position Title *

Start Date *

End Date *

Duties Performed *

Reason for Leaving *

Reference Contact Name *

Reference Contact Phone *

Reference Contact Name

Reference Contact Phone

Health *

I declare that all statements below are answered truthfully to the best of my knowledge. I understand that this information is vital to my potential employer and will assist in mitigating any risks to my heal or others while I am employed.

Have you ever been diagnosed with a health condition such as:Cardiovascular diseaseLung disease/asthmaHigh blood pressureStrokeEpilepsyDiabetesSleep Apnea

Have you experienced any pain or injuries to the following:HeadBackNeckLeg(s)Arm(s)Hand(s) and/or Wrist(s)Foot/Feet and/or Ankle(s)

Have you any other pre-existing injuries or medical conditions (including industrial disease) that may be aggravated by performing the job role you are applying for?* *YesNo

Are you taking any medication (short-term or long-term)? *YesNo

Do you have any physical impairment which would affect your ability to work or prevent the wearing of personal protective equipment? *YesNo

I agree to undertake a pre-employment medical (by a Company assigned GP) should this be required prior to any offer of employment to ascertain my medical suitability for the inherent requirements of the position applied for. *YesNo

AVAILABILITY

Days available to work *MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Days Or Nights *DaysNights

Are you able to work overtime? *YesNo

Are you available to accept callouts at any given time? *YesNo

Are you available to work away on remote projects? *YesNo

Are you able to start immediately? *YesNo

DRIVING/CRIMINAL HISTORY

Within the last five (5) years have you ever:

Had any insurance cancelled or refused? *YesNo

Had any special conditions imposed? *YesNo

Received any fines for driving infringements? *YesNo

Lost your licence? *YesNo

Returned a positive test result when tested for either drugs or alcohol? *YesNo

Been convicted of any drug, alcohol or criminal offences? *YesNo

CONFIRM & SUBMIT

Your Resume *

No file chosen

How did you find out about Trafficcom? *

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 my employment if my application proves successful in gaining employment. *

I understand that this application does not constitute an offer of employment. *

I understand that, in some cases, police and driving checks will be required and I will be notified if this applies to this application. *

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