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Labourplus & NSSA Security Registration Form





PERSONAL DETAILS * This section must be completed first to proceed to other sections

PERSONAL DETAILS

Name :  
Licence Number :  
Security Company :  
Registration Date :  
State :
Title :
Given Name :  
Second Name :
Last Name :  
Gender :  
Date of Birth :  
Place & Country of Birth :  
Contact Phone :    
Email :
  This would be used as your username
   
Confirm Email: :
 
        
Street Address :  
Suburb/Town :  
State :
PostCode :  
Postal Address is as same as above ? :
Street Address :  
Suburb/Town :  
State :
PostCode :  

EMERGENCY CONTACT

Name :  
Relationship :  
Contact Phone :    

RIGHT TO WORK IN AUSTRALIA


Labourplus is required to check that each applicant is entitled to work in Australia. You are required to provide proof of your right to work in Australia with this Registration of Interest. Please ensure the proof that you upload is clear and complete. Proof uploaded that is unclear will NOT be accepted.

Please select one of the following that you will provide, and please complete the below section as applicable :




 
 
No files uploaded
No files uploaded
No files uploaded

If you have a valid visa with permission to work in Australia, do you give Labourplus permission to check the validity of your visa as required by the Department of Immigration and Citizenship (DIAC) through the Visa Entitlement Verification Online facility (VEVO)? :
 

How did you hear about Labourplus?
   

SECURITY INDUSTRY LICENCES

Please select your relevant State :






 
File Name FileID 
Danica_Rizzo-IdentificationProof Download 4973Delete

You are required to provide a copy of both sides of your licence card as issued by the your relevant states issuing office.
No files uploaded

You are required to provide a copy of both sides of your licence card as issued by the your relevant states issuing office.
No files uploaded

 
 

During the time since your Security Licence/s were issued, have you ever:
Been involved in an investigation by any authority including the Police?
 
Had your Security Licence/s suspended or revoked?
 
Had your Drivers Licence suspended or revoked?
 
If you answered Yes to any of the above questions, please provide details and dates of the incident: :
 
Additional qualifications - Please select from the following (provide photocopies)
 
No files uploaded

No files uploaded

File Name FileID 
Danica_Rizzo-FileUploadConstructionCard Download 4956Delete



File Name FileID 
Danica_Rizzo-FileUploadPoliceClearance Download 4957Delete

EMPLOYMENT HISTORY IN YOUR RELATED INDUSTRY - Please fill fields as applicable


Labourplus may contact your past employer/s for a reference. Do you provide permission for Labourplus to contact your past employer/s?

Company Name :
Job Title :
Tasks Performed :
Period of Employment :
Employer Contact Number :
Employer Contact Name :

Company Name :
Job Title :
Tasks Performed :
Period of Employment :
Employer Contact Number :
Employer Contact Name :

CURRENT EMPLOYMENT
Are you currently employed?
If you answered Yes, please provide the following details:
Employer Company Name :
Position held :
Industry :
Average hours worked per week :
Employer Contact Number :
Employer Contact Name :

Do you provide permission for Labourplus to contact your current employer?

EDUCATION & ADDITIONAL INFORMATION - Please fill fields as applicable


Education * Please select only one option from the choices below
Did you attend Secondary school?
If Yes, highest level completed?
Did you attend College or TAFE?
Did you attend University?
Specialised training or courses?
If you answered Yes to any of the above questions, please provide further details:

ADDITIONAL INFORMATION * Please select only one option from the choices below
Please select the following options that best describe your personal skills and current situation:
I am able to speak English
I am able to read English
I am able to write in English
I have my own transport to attend work
I have access to public transport to attend work
I can be available on short notice
I can be available for weekday shifts
I can be available for weeknight shifts
can be available for weekend day shifts
I can be available for weekend night shifts
I can work 12 hour shifts
I can be available for work outside the metropolitan area

FITNESS FOR WORK


Please answer the following questions truthfully and accurately. If it is subsequently discovered that you have provided false or misleading information in this Registration of Interest, it may result in immediate termination of employment with Labourplus and may result in any workers compensation claim being denied by the relevant authority.

Have you ever had or received treatment or medical advice for any of the following?
Heart problems including heart attack / angina/heart surgery
High or low blood pressure
Lung problems including asthma /collapsed lung/ chronic bronchitis, etc
Diabetes
Hernia
Seizures / fits / blackouts / epilepsy
Panic attacks
Stress, anxiety or depression
Persistent headaches/ migraines
Alcohol dependence or substance abuse
Allergic reactions i.e. medications, foods or bee stings
Have you ever had any operations
Have you ever been hospitalised
Any skin conditions i.e. eczema, dermatitis or skin rashes
Any problems with your ears i.e.: burst eardrums, problems equalizing or loss of hearing
Arthritis /rheumatism in any joint
Repetitive strain or overuse injury
Back problems including pain, sciatica and/ or whiplash
Neck problems including pain and/or whiplash
Any bone fractures or dislocations
Pain in your shoulder, hip, knee, ankle, elbow or wrist
Injury from a motor vehicle accident
Any other medical conditions which could increase your risk of injury at work or place others at risk

Does any of the following apply to you?
Are you taking any medications of any type
Do you take any illicit or recreational drugs
Have you ever had a Workers Compensation claim or any work related illness or injury
Do you have a current Workers Compensation claim
Have you had any time off work in the past year (5 days or more) due to any illness or injury
Are you currently being treated by a doctor, physiotherapist or chiropractor for any injury or illness
Have you ever been refused life /disability insurance, military service or employment
Is there any reason why you cannot wear personal protective equipment (PPE)
Do you drink alcohol? If yes, please list weekly amount: And type:
Do you smoke? If yes, please list daily amount: Age when started:

Do you have any difficulty with any of the following activities?
Running 100 metres
Walking on rough ground
Kneeling
Standing for 3 hours
Sitting for 3 hours
Concentrating on what you are doing
Lifting or bending
Pushing or pulling
Repetitive movement of hands or arms
Seeing (reading, long distance, night)
Reading and/or understanding English
Hearing a normal conversation
Shift work
Sleeping

QUIZ * button to the quiz is enabled only once the above steps are completed