Australasian Drilling Institute - Member Application

Personal Details

First Name :

Other Name:

Surname:

Date Of Birth:

Residential Address:

Street Address:

Country:

City/Town:

State:

Postcode:

Postal Address: Same As Above

Street Address:

Country:

City/Town:

State:

Postcode:

Telephone:

Mobile:

Fax:

Email:

Preferred Method of Contact:

Post
Email
Phone
Mobile
Fax

Preferred Time of Contact:

Gender:

Male
Female

Place Of Birth:

I would like to Recieve the Newsletter by Email

Emergency Contact #1

Name:

Relationship:

Phone:

Emergency Contact #2

Name:

Relationship:

Phone:

Application

Course Applying For:
Have you ever applied for a position/training with Australasian Drilling Institute before?	Yes No

Licences

Driver's Licence

Forklift Licence

Other Licence

Certificates

First Aid Certificate		Expiry Date:
Mine Workers Health Certificate		Expiry Date:
MARCSTA Induction Number:		Expiry Date:
GENERIC Induction Number:		Expiry Date:

Other Certificate:

Expiry Date:

Education

Secondary Education		Level Completed:
School:		Last Year Attended

Tertiary Education:

Trade Apprenticeship
Served with:		Trade:
Certificate Number:		State:

Indentured Apprenticeship:
From:		To:

Spouse / Dependant Details

The section below to be used for special occasions, eg. Allocation of Christmas presents for children. This section is not compulsory to complete.
Spouse Full Name:
Dependants Boys:

Name:

Date of Birth:

Dependants Girls:

Name:

Date of Birth:

Leisure Activities

Sports / Hobbies / Interests
Club Membership / Community Services

Physical

Current Employment Status

Are you currently employed?	Yes No
How much notice must you give to your present employer?	Weeks

Employment History

Past Employment Record #1 (Please enter a minimum of three past employment records)

Company Name:		Position Title:
Reporting To (Title):		Reason for Leaving:
Employment Start Date:		Employment Finish Date:
Description of duties:
Past Employment Record #2 (Check this box to enter multiple past employment records)

Referees

Please enter a minimum of three referees
Name:	Telephone:	Position / Title:

Major Experience

Rigs Operated

Type of Rig:

Months Worked:

Systems Used and Sizes:

Other Experience - Please Specify:

Medical History

Have you ever experienced any accidents that required hospitalization? If so, how much time?
Have you received Worker's Compensation for any injury or disease:		Yes No

Declaration By Applicant

I declare:

a) That the answers to the above questions are to be best of my knowledge true and correct in every particular.

b) That I agree to undergo a medical examination (at the expense of the employer) as may be requested by the employer.

c) I agree to abide by the conditions set out in the notes, if offered a position with Australasian Drilling Institute Pty Ltd.

d) I understand that if I am employed and it is subsequently established that I have been misleading or untruthful, I may be terminated from employment.

e) I consent to the release of information and reference check requirements as stated under the Privacy Legislation requirements as stated in this application.

I have read and understand the contents of this document.

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Australasian Drilling Institute Recruit Application