Double X Trucking Group Pty Ltd.

Suite 305, 447 Victoria St Wetherill Park 2176
ABN: 91 165 949 879
PH: (02) 97566177
EMAIL: info@dxtg.com.au

Employment and Work Compliance





Employment Application Form





Truck Driver Employment Application


General Information

Date of Application: Position Applied For:

First Name: Middle Name: Last name:

Date of Birth:

Telephone: (Home)

Mobile:

Email:

Address:



Emergency Contact

Name:

Relation:

Contact Number:

Truck Driver Employment Application



Convictions / Offences

Please state whether there have been any convictions in the previous 5 years:

Type

Yes (Tick)

No (Tick)

Alcohol

Drug Offences

Negligent Driving

Dangerous Driving

Culpable Driving

Criminal

Have you been involved in any accidents in the previous past 5 years?

Have you ever had your licence declined or cancelled?

If you answered YES to any of the above, please give details of offences and/or court appearances.

Are you prohibited to work with children? Yes   No

Truck Driver Employment Application



Work References

Please list record of work (in relation to truck driving) commencing with your most recent employer/contractor, over the past 10 years.

Name of Employer

Type of Operations

(Job Description)

Number of Years at Company

1

2

3

4


Member of Professional Associations

Name of Association:

Member Number:

Truck Driver Employment Application



Payroll and Accounts

Are you permitted to work in Australia? Yes   No

Tax File Number: - -

Payslip Email:



Payment Details:

Bank:

Branch:


Account Name

BSB

- -

Account Number

- -

Truck Driver Employment Application



Medical Questionnaire

#

Condition

Yes

No

Medication

Treatment Details

1

Asthma, Fever, Sinusitis, Bronchitis or Breathlessness

2

Allergic to any drugs, substances, food, materials, climate, dust?

3

Migraine or Severe Headaches

4

High or Low Blood Pressure

5

Skin Problems, rashes, reactions to substances, dry skin, bites?

6

Infectious diseases; e.g. Hepatitis, Chicken pox, Measles etc?

7

Have you had any Vaccinations (Childhood, Work, and Travel)?

8

Epilepsy, Fainting Fits or Blackouts?

9

Any History of serious illness as a child or adult?

10

Any Fractures, Joint pain or muscular injury, strain (body parts)?

11

Any problems with varicose veins or feet problems (bunions, swollen ankles etc)?

12

Ear Infections. Injuries or Hearing loss?

13

MVA, sporting injuries, work related injury or illness?

14

Any claim of injury or occupation illness?

15

Have you ever worked in dusty or noisy environments?

16

Work involving heavy lifting, repetitive movement/lifting?

17

Are you presently on any medications?

18

Have you ever undergone any operations?



Declaration:

I declare that the above information is accurate to the best of my knowledge. I understand this information is required to ensure health and safety of myself in carrying out my duties.

If the information given requires the company to have my treating doctor’s approval to perform the tasks, I agree to provide the company a letter from my doctor stating this to be.

Applicant Name:

Truck Driver Employment Application





Agreement

To be read and signed by all applicants:

It is agreed and understood that:


  • Completing this application will in no way assure that I will be employed.

  • This application was completed by me; all entries on it and information in it are true and are completed to the best of my knowledge. Any misinterpretations of information give shall be considered an act of dishonesty and I understand that any falsification and misrepresentation herein could result in my discharge in the event that I employed by DXTG. I will furnish freely such information of documents that may be requiring completing my employment file.

  • I hereby authorize DXTG to investigate my previous record of employment to ascertain any and all information which may concern my record whether same as on record not and I release my former employer from all liability for any damages on account of furnishing such information.

  • In the event of my leaving for any cause, I authorize DXTG to answer any and all enquiries as to my conduct and qualifications while working for the company, and reason for leaving.

  • I agree that whenever I leave whether it may be voluntary or involuntary, I will return all company property. Otherwise, I understand the cost is to be paid by me.

  • If DXTG requires consent to undertake a medical examination at the existing condition/ailment to the company, provided that such information is treated with sensitivity and confidentiality.

  • If offered employment with DXTG, I understand that my employment conditions are as expressed in the policies, procedure and standard conditions of employed contained in the Employment & safety handbook and summarize in the workplace safety booklet which will be issued to me on commenced of employment.

Applicant Name:

Date: