First Name

Last Name

Address (include city, country and postcode)

Phone Number

Email Address

Emergency Contact Name

Emergency Contact Phone Number

Are you an Australian citizen or permanent resident? Are you an Australian citizen or permanent resident? Yes No

Are you eligible to work in Australia? Are you eligible to work in Australia? Yes No

Visa Details

Do you have a licence to drive a motor vehicle in Australia? Do you have a licence to drive a motor vehicle in Australia? Yes No In the process of gaining validation

Do you have your own vehicle? Do you have your own vehicle? Yes No

Driver’s Licence Number:

Do you have a current First Aid & CPR certificate? Do you have a current First Aid & CPR certificate? Yes No

Work with ACH is likely to include long hours on a continuous basis. Do you have a level of fitness that can handle the daily rigours of a physically demanding role? Work with ACH is likely to include long hours on a continuous basis. Do you have a level of fitness that can handle the daily rigours of a physically demanding role? Yes No

Are you taking any prescription medicines that may affect your ability to operate heavy machinery? Are you taking any prescription medicines that may affect your ability to operate heavy machinery? Yes No

Have you ever been involved in an employment or farm related accident? Have you ever been involved in an employment or farm related accident? Yes No

If yes, please provide details

Have you been convicted of driving under the influence of alcohol or drugs within the past 5 years? Have you been convicted of driving under the influence of alcohol or drugs within the past 5 years? Yes No

Do you agree to random drug & alcohol testing that may be conducted in the workplace? Do you agree to random drug & alcohol testing that may be conducted in the workplace? Yes No

Have you had harvest experience? Have you had harvest experience? Yes No

Please include any relevant experience you may have had