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To complete your application please fill in the form below.

    Contact Details
    Background Information


    NoYes


    YesNo

    YesNo

    Qualification Year Finalised Name of School or training provider Location
    Secondary (High School)
    Tertiary (Uni) or Tafe
    Trade Studies
    Other Courses

    (Please complete most recent employment first)


    To

    To


    To

    To

    Skills, Qualifications and Experience

    From the list below please identify all skills, qualifications and experience that you have obtained during your work history. Where you indicate you hold a licence, industrial ticket or qualification, a copy will need to be provided prior to commencement of employment.


    Licences, Tickets and Certificates State Number Expiry Date
    YYYY-MM-DD
    Basic workplace 1st Aid
    Senior 1st Aid
    1st Aid
    Other:
    DTEC
    Four wheel Drive tkt

    Inductions Number Date
    YYYY-MM-DD
    Induction – BHP
    Induction – BHP
    Induction – BHP Rail (lev 2)
    Induction – BHP Rail (lev 4)
    Induction – Dampier Salt
    Induction – Port Authority
    Induction – Team 45
    Induction
    Other:
    Mine Health Worker

    Application for Employment
    Industrial
    Application for Employment
    Do any of the following apply to you? No Yes If Yes, please provide details:
    Physical disability that impacts on your ability to perform the work you are looking for No Yes
    Loss of hearing or hearing aids No Yes
    Loss of long or short vision, or corrective lenses No Yes
    Allergies that result in physical symptoms No Yes
    Problem working at heights No Yes
    Requirement to take prescribed medication No Yes

    .

    Do any of the following apply to you? No Yes If Yes, please provide details:
    Occasional or on going back or neck pain No Yes
    Bone fractures or dislocations No Yes
    Occasional or ongoing knee or ankle pain No Yes
    Occasional or ongoing shoulder, elbow or wrist pain No Yes
    Arthritis or rheumatism No Yes
    Severe injuries or operations No Yes
    Angina or heart problems No Yes
    High blood pressure No Yes
    Asthma, tuberculosis or pleurisy No Yes
    Asthma, tuberculosis or pleurisy No Yes
    Hernia No Yes
    Kidney or bladder problems No Yes
    Cancer or tumour, including skin cancer No Yes
    Depression or anxiety No Yes
    Epilepsy, fainting or fitting No Yes
    Persistent headaches No Yes
    Medical examination in the last 12 months No Yes If yes can you provide a copy?
    Workers compensation claim No Yes
    c) Are you suffering from any other injury, physical or mental condition that has not been stated above that may impact on your ability to perform the duties you are looking for? No Yes
    Emergency Contact Details

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    • To any organisation to which IMMS currently or may in the future provide employment services,
    • To Contracted service providers which IMMS may use to perform services on its behalf (such as banks, IT service providers, etc)
    • Where we are under a legal duty to do so, including circumstances where we are under a lawful duty of care to disclose information.

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