type":"paragraph","subtype":"p","label":"

__________________________________________________________________________________

"},{"type":"header","subtype":"h1","label":"

Personal Information

"},{"type":"text","required":true,"label":"

Address

","className":"form-control","name":"text-1701224302279","subtype":"text"},{"type":"text","required":true,"label":"

Contact Number

","className":"form-control","name":"text-1701224313938","subtype":"text"},{"type":"text","required":true,"label":"

Date of Birth

","className":"form-control","name":"text-1739855862176","subtype":"text"},{"type":"checkbox-group","required":true,"label":"

Are you an Australian Citizen?

","toggle":false,"inline":true,"name":"checkbox-group-1701224445171-0","other":false,"values":[{"label":"Yes","value":"Option-1","selected":false},{"label":"No","value":"Option-2","selected":false}]},{"type":"checkbox-group","required":true,"label":"

If not, do you have a Working Visa?

","toggle":false,"inline":true,"name":"checkbox-group-1701224678719","other":false,"values":[{"label":"Yes","value":"Option-3","selected":false},{"label":"No","value":"Option-4","selected":false}]},{"type":"checkbox-group","required":true,"label":"

Have you ever been convicted of an offence?

","toggle":false,"inline":true,"name":"checkbox-group-1701224738154","other":false,"values":[{"label":"Yes","value":"option-7","selected":false},{"label":"No","value":"Option-8","selected":false}]},{"type":"checkbox-group","required":true,"label":"

If successful gaining employment, are you willing to undergo a Pre-Employment Medical and random Drug & Alcohol Screenings?

","toggle":false,"inline":true,"name":"checkbox-group-1701224873967","other":false,"values":[{"label":"Yes","value":"option-9","selected":false},{"label":"No","value":"Option-10","selected":false}]},{"type":"checkbox-group","required":true,"label":"

Are you of Aboriginal or Torres Strait Islander origin?

","toggle":false,"inline":true,"name":"checkbox-group-1701224742804","other":false,"values":[{"label":"Yes","value":"Option-5","selected":false},{"label":"No","value":"Option-6","selected":false}]},{"type":"paragraph","subtype":"p","label":"

__________________________________________________________________________________

"},{"type":"header","subtype":"h1","label":"

Position

"},{"type":"textarea","required":false,"label":"

What position are you applying for?

","className":"form-control","name":"textarea-1701231411331-0"},{"type":"textarea","required":true,"label":"

Available start date?

","className":"form-control","name":"textarea-1701231427986"},{"type":"textarea","required":true,"label":"

Desired Pay (Hourly)

","className":"form-control","name":"textarea-1701231467759"},{"type":"textarea","required":false,"label":"

Desired Hours (Fortnightly)

","className":"form-control","name":"textarea-1701231556943"},{"type":"paragraph","subtype":"p","label":"

__________________________________________________________________________________

"},{"type":"header","subtype":"h1","label":"

Fitness for Work Information

"},{"type":"paragraph","subtype":"p","label":"

Note: The information you provide in this section may be made available to the insurer in connection with any claim for workers compensation, so it is important that your answers are correct. Section 79 of the Workers Compensation and assistance Act 1981 gives the Workers Compensation Board discretion to refuse to award compensation which would otherwise be payable, where it is proved that the worker had, at the time of seeking or entering employment, willfully and falsely represented himself/herself as not having previously suffered from the disability, the subject of the claim for compensation. Any willfully misleading or falsely represented information provided here may jeopardize any future claim and may also be an offense under the relevant accident compensation legislation.

"},{"type":"checkbox-group","required":true,"label":"

Do you have any disability, condition, or injury likely to or which may affect any aspect of your work performance which could be aggravated or accelerated as a result of the employment you seek?

","toggle":false,"inline":true,"name":"checkbox-group-1701315116820","other":false,"values":[{"label":"Yes","value":"option-11","selected":false},{"label":"No","value":"Option-12","selected":false}]},{"type":"textarea","required":false,"label":"

If Yes or Other, please provide details:

","className":"form-control","name":"textarea-1718590043961"},{"type":"checkbox-group","required":true,"label":"

Have you ever suffered from: (please tick if yes)

","toggle":false,"inline":false,"name":"checkbox-group-1701315303130","other":true,"values":[{"label":"Back or Neck Pain?","value":"back-neck-pain","selected":false},{"label":"High blood pressure or heart problems?","value":"heartproblems","selected":false},{"label":"Sleep Apnea?","value":"apnea","selected":false},{"label":"Asthma?","value":"asthma","selected":false},{"label":"Fits / blackouts / seizures?","value":"blackouts","selected":false},{"label":"Joint problems / fractures?","value":"fractures","selected":false},{"label":"Visually impairment?","value":"impairment","selected":false},{"label":"Headaches or persistent Migraines?","value":"migraines","selected":false},{"label":"Do you use any recreational drugs? If yes, please give details below","value":"rec-drugs","selected":false},{"label":"Do you use any prescription drugs? If yes, please give details below","value":"prescription-drugs","selected":false},{"label":"Do you have a medical marijuana certificate? If yes, please give details below","value":"medical-marijuana-certificate","selected":false}]},{"type":"textarea","required":false,"label":"

If Yes or Other, please provide details:

","className":"form-control","name":"textarea-1701317273513"},{"type":"paragraph","subtype":"p","label":"

__________________________________________________________________________________

"},{"type":"header","subtype":"h1","label":"

Other Information

"},{"type":"textarea","required":false,"label":"

What class/es of Drivers Licence do you currently hold?

","className":"form-control","name":"textarea-1717731745037"},{"type":"checkbox-group","required":true,"label":"

Has your driver’s license ever been suspended or cancelled?

","toggle":false,"inline":true,"name":"checkbox-group-1701317391314","other":false,"values":[{"label":"Yes","value":"option-17","selected":false},{"label":"No","value":"Option-18","selected":false}]},{"type":"checkbox-group","required":true,"label":"

Have you had any traffic convictions and/or traffic offences and/or been involved in any motor vehicle accidents in the past five (5) years?

","toggle":false,"inline":true,"name":"checkbox-group-1701317419551","other":false,"values":[{"label":"Yes","value":"option-19","selected":false},{"label":"No","value":"Option-20","selected":false}]},{"type":"paragraph","subtype":"p","label":"

__________________________________________________________________________________ Please fill in all fields if possible. If you are attaching your resume and details can be found on there, enter \

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