CCR Group Pty Ltd are constantly seeking qualified personnel for shutdowns, site maintenance, projects and construction works. This includes Boiler Makers, Welders, Riggers, Fitters and Trade Assistants. Employment 2 (All sections of this form must be completed to be considered for employment with CCR Group) Personal Details Position Applied For: * Date * Title * Mr.Mrs.Ms.Miss. Surname * Given Name(s) * Residential Address * Suburb * State * ACTNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriuaWestern Australia Postcode * Mobile * Email * DOB * Place Of Birth * Nationality * Are you an Australian Resident * Yes No Visa Required * Emergency Contact Name * Name First First Surname Surname Relationship * Mobile Workers Compensation History Have you ever had any workers compensation claims? * Yes No Resume and Qualifications Type * PDF * Drop a PDF here Choose File Maximum file size: 5MB plus1 Add minus1 Remove Employer Details Employer Name * Date * Injury * plus1 Add minus1 Remove Occupational Health & Safety Are you being treated for any illness, or taking any medication for a medical condition? * Yes No Do you have any medical condition(s) that need to be monitored regularly; or any medical issues that would affect your ability to do your job safely? * Yes No Do you have any known occupational allergies? Yes No Do you have any other condition that could impact on your work, safety or that of others? * Yes No Do you have diabetes? * Yes No Have you been hospitalised for any condition within the last year? * Yes No Do you smoke? * Yes No If so, are you prepared to adhere to all site smoking policies? * Yes No Are you prepared to undergo a pre-employment medical and D&A, and ongoing random D&A? * Yes No Would you currently pass a drug and alcohol screen? * Yes No Do you have, or have you ever had any of the following: Lung problems/asthma/bronchitis? * Yes No Fits/seizures/blackouts/ persistent headaches or migraines? * Yes No Joint problems/fractures /carpel tunnel? * Yes No Repetitive strain/overuse injury? * Yes No Mental or nervous trouble? * Yes No High blood pressure/heart trouble? * Yes No Back or neck problems? * Yes No Loss of hearing/ ear trouble? * Yes No Do you have any difficulty completing the below activities? Running, walking or kneeling? * Yes No Repetitive hand and arm movements? * Yes No Standing for lengthy periods? * Yes No Climbing ladders? * Yes No Turning your head? * Yes No Crouching or squatting? * Yes No Using hand tools/ gripping firmly with both hand? * Yes No Sitting for lengthy periods? * Yes No Hearing? * Yes No Lifting or bending? * Yes No Reading ordinary newsprint? * Yes No Understanding English? * Yes No Comments Declaration Declaration: Please note it is imperative you provide full and accurate information within this section, as failure to comply may result in any future workers compensation claims being denied. This is in accordance with Section 79 of the Workers Compensation and Injury Management ACT 1981 which states: "Where it is proven that the worker has, at the time of seeking and entering into employment in respect of which he/she claims compensation for a disability, wilfully and falsely representing themselves as not having previously suffered from disability, a dispute resolution body may, in its discretion refuse to award compensation which would otherwise be payable." Providing this information to CCR is not a barrier to consideration of employment, but ensures you are placed in the most appropriate role. By initialling the page below; I confirm that; - I certify that the information provided in this document is true and completed to the best of my knowledge. - I understand that failing to notify or concealing pre-existing injury/illness which might affect the nature of work carried out whilst employed by CCR could result in that injury/illness being ineligible for future compensation claims. Declaration * I confirm that I; Understand by completing relating to my employment, and give permission for my references to be contacted. Have completed this form with true and accurate information to the best of my knowledge, and understand that any deliberately false or misleading information I have given may lead to termination. Declare that I am medically fit for the proposed position If you are human, leave this field blank. Submit
