Terrex Seismic Careers Opportunity Form

Do you hold a current First Aid Certificate?

Yes No Please specify a value.

If Yes Give Details

Do you hold any current Trade Certificates or Qualifications that will assist your application?

Yes No Please specify a value.

If Yes Give Details

Do you hold a current MARCSTA or QLD Generic Induction?

Yes No Please specify a value.

If Yes Give Details

Any additional details to support your application?

I have given a true and correct statement and understand that all information is confidential.
I understand that any offer of employment is subject to a medical examination by a qualified medical practitioner and a drug screening.
Yes Please check 'yes' to confirm the statement above.

If a resume is required you will be contacted by a company representative.

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Position Applied for	A value is required.	Email	Invalid format.
Surname	A value is required.	Other Names	A value is required.
Address	A value is required.
State	Please select an item.	Postcode	A value is required. Invalid format.
Home Tel No		Mobile	A value is required.
Are you an Australian resident and eligible to work in Australia?	Yes No You must be eligible to work in Australia to complete this form.Please specify a value.

Aust Drivers License You must hold a valid manual Australian drivers license in order to apply for this position	A value is required.	State/Classes	A value is required.
Expiry Date (dd/mm/yy)	A value is required.Invalid format.	Is your license suspended?	Yes No Please specify a value.

Do you have a medical condition	Yes No Please specify a value.	If yes give details
Any formal offer of employment is subject to the prospective employee undergoing a medical screening and a 5 panel drug test performed by a qualified medical practitioner.

Current/Last Employer
Company		Position
Contact Person		Telephone
Date From		Date To
Reason For Leaving
Previous Employer 1
Company		Position
Contact Person		Telephone
Date From		Date To
Previous Employer 2
Company		Position
Contact Person		Telephone
Date From		Date To

Reference 1
Name		Telephone
Reference 2
Name		Telephone

Terrex Seismic Career Opportunities Form

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