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APPLICATION FOR EMPLOYMENT Private & Confidential

1. Personal Details Surname _________________________________________________________________________ Given Names ______________________________________________________________________ Address (No.) ___________ (St.) _________________________________________________ Suburb ______________________________ Postcode ________________________ Phone number (H) _____________________________ (W)_____________________________

Position applied for _______________________________ Location _______________________ In the course of your employment you may be required to travel to other locations. Do you hold a current driver's licence? (please tick) YES Are you an Australian citizen? (please tick) YES If you are not an Australian Citizen and if you do not have the right to permanent residency in Australia, then: Do you have a work permit (please tick) YES NO

NO NO

If YES, write Visa/Passport Number: ___________________________________________________ Are you eligible for a Government Subsidy? (please tick) YES NO

If YES, indicate period (weeks) and amount ________________ WEEKS ______________ AMOUNT Do you know of any reason or commitments which may interfere with your work attendance? (eg: armed forces reserve, studies etc) YES NO If YES, give details: _________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 2. Personal Details Please indicate the times during which you are available to work.

MONDAY START TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

FINISH

Are you prepared to work on Public Holidays? (please tick)

YES

NO

3. Education Type of Education Secondary (High School) School/College Name & Address Duration of Studies Name of Course Level Achieved

Tertiary (University)

TAFE

Please list any other training courses you have attended and the date and name of the organisation running the course. For example: Workplace First Aid ­ St Johns Ambulance Service 1996. _________________________________________________________________________________ _________________________________________________________________________________ List any other skills you possess. For example: typing, computer, MSWord, Excel, other skills. _________________________________________________________________________________ _________________________________________________________________________________

4. Employment Record & Referees Please list your most recent position first. Employer Name Contact No. Dates From - To Position Duties & Responsibilities Reason for Leaving

1.

2.

3.

5. Employment Record & Referees Can we contact your current employer? (please tick) If not previously stated, have you previously worked at Timezone? YES YES NO NO

If YES, when and where? ____________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Please supply the name, position and telephone number of at least two referees we may contact (preferably work related):

Name

Position

Telephone

1. 2. 3. 6. Health Record Hearing (please tick) Eyesight (please tick) GOOD GOOD AVERAGE AVERAGE YES FAIR FAIR NO

Do you have any physical or other health disabilities which would prevent you from performing the requirements of this position?

If YES, please describe: _____________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Are you on any medication? (please tick) YES NO

If YES, what type(s)? ________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Are you prepared to undergo a pre-employment medical examination? (please tick) YES NO

7. General Information To give us more information about how you would suit our company, please complete the following questions. 1. Why do you want to join Timezone? __________________________________________________ _________________________________________________________________________________ 2. What does `customer service' mean to you? ____________________________________________ _________________________________________________________________________________ 3. If your application is successful, how would you travel between work and home? _______________ _________________________________________________________________________________ 4. What was your greatest achievement in your current/last job, or at school?____________________ _________________________________________________________________________________ 5. What skills and abilities would you bring to our business? _________________________________ _________________________________________________________________________________ Declaration I authorise Timezone to obtain any information (the `information') about me in relation to this application. I release any person, firm or institution from any liability for any damage incurred by me however arising from the disclosure of the information. I understand that as a condition of my employment Timezone has the right to inspect personal belongings whilst I am acting in my capacity as employee and am situated on any premises either owned or leased by Timezone. I declare that I am one and the same person named in this application and as described in the drivers licence, birth certificate/passport or any other form of identification reasonably required by Timezone. I further declare that the statements made by me in this application are true, complete and correct. I understand that a false or misleading statement or dishonest answer in this application will be regarded as serious and wilful misconduct and will be grounds for instant dismissal from employment. Applicant's Signature: ___________________________________ Date: _______________________ Print Name____________________________________________

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