PERSONAL DETAILS

Gender	Male Female
Name
Suburb	Postcode
Phone	Mobile
Email Address
Driver's Licence No.
Birthday	--Select-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --Select-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Relationship	--Select-- Single Married Defacto Seperated Divorced Widow Next of Kin
Best time to call	--Select-- Morning Afternoon Evening How did you hear about us? --Select-- Newspaper Radio Magazine Website Television Referral

Position applying for

--Select-- Administration Consultant Office Support Sales Marketing

Name
Position
Property/Company
Telephone
Contact Name

Name
Position
Property/Company
Telephone
Contact Name

Name
Position
Property/Company
Telephone
Contact Name

EMPLOYMENT

Previous Employer
Start Date
End Date
Main role/s
Reason for leaving

Previous Employer
Start Date
End Date
Main role/s
Reason for leaving

Previous Employer
Start Date
End Date
Main role/s
Reason for leaving

GENERAL

Please provide any information that you consider relevant to your application.

Is there anything to your knowledge which would limit your ability to perform the duties of the position, including injuries, medical conditions and/or level of fitness?

DECLARATION BY APPLICANT

I declare that the information I have provided is true and correct to the best of my knowledge. I authorize Platinum to collect information from previous employers and others, including but not limited to nominated referees to determine my suitability for employment.

YES, I agree to these conditions.