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About
Services
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Employment
Driver Induction
Forms
Employee Payroll
Employee Profile
Contact
02 6035 4354
admin@daysoak.com
Home
About
Services
Our People
Employment
Driver Induction
Forms
Employee Payroll
Employee Profile
Contact
Home
About
Services
Our People
Employment
Driver Induction
Forms
Employee Payroll
Employee Profile
Contact
Employee Profile
Employee Profile and Declaration Form
"
*
" indicates required fields
Employee Details
First Name
*
Last Name
*
Date of Birth
*
DD slash MM slash YYYY
Home Phone No.
*
Email
*
Mobile No.
*
Residential Address
*
Town
*
State
*
Postcode
*
Postal Address
Town
State
Postcode
Your pre-employment medical examination will include a drug and alcohol test and is a condition of employment
I understand that it is a condition of employment that I will undertake a Drug and Alcohol Test as part of my Pre -employment Medical.
Sign
*
Date
*
I understand that if I undertake a Drug and Alcohol Test and show a
non negative
result that Days may choose not to employ me
Sign
*
Date
*
I declare that the details shown in this application are true and correct and that I have read and understood the General Information section of this form.
Sign
*
Date
*
Personal Medical Details
A pre-employment medical examination which includes a drug and alcohol test is a condition of employment.
Drugs and Alcohol
Have you ever sought assistance for alcohol use issues?
*
Yes
No
Do you drink alcohol?
*
Yes
No
How often do you drink alcohol?
*
1
2
3
4
5
1
2
3
4
5
Never
Monthly or less
2-4 times per month
2-3 times per week
4 or more times per week
How many drinks would you drink on a day when you do drink?
*
1
2
3
4
5
1
2
3
4
5
1 or 2
3 or 4
5 or 6
7 or 8
More
Have you ever sought assistance for drug use issues?
*
Yes
No
Do you use drugs whether prescribed by a doctor or not?
*
Yes
No
Do you use illicit drugs?
*
Yes
No
Do you use drugs or medications NOT prescribed by a doctor?
*
Yes
No
Have you driven a vehicle while on drugs or medications not prescribed by a doctor?
*
Yes
No
Have you been involved in a vehicle accident while on drugs or medications not prescribed by a doctor?
*
Yes
No
Have you been charged by police for being in charge of a vehicle while under the influence of drugs?
*
Yes
No
Do you have any physical or medical condition that prevents or restricts you from undertaking certain kinds of work?
*
Yes
No
If Yes, please provide details below
Are you currently attending a health professional for any illness, injury or disability?
*
Yes
No
If Yes, please provide details below
Do you take any medication/s that prevents or restricts you from undertaking certain kinds of work?
*
Yes
No
If Yes, please provide details below
Have you ever made a claim for worker's compensation?
*
Yes
No
If Yes, please provide details below
When
DD slash MM slash YYYY
Injury
Outcome
Employment History
Last Employer Name
Address
Position Held
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
Reasons for Leaving
2nd Last Employer Name
Address
Position Held
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
Reasons for Leaving
References
Please provide details of at least 2 people that you agree to let us contact.
Name
Company/Title
Contact Number
Add
Remove
Driving Experience
Type of Equipment
Dates
Approx. # of km driven
Rigid Truck
Select an Equipment
Tautliner
Tanker
Flat-top
B-Double
Road-train
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
KM
Prime Mover & Semi-Trailer
Select an Equipment
Tautliner
Tanker
Flat-top
B-Double
Road-train
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
KM
Prime Mover with Multiple Trailers
Select an Equipment
Tautliner
Tanker
Flat-top
B-Double
Road-train
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
KM
Other
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
KM
Please provide the names of the highways on which you have predominantly driven over the last 5 years
Please provide details of training you have completed in relation to your driving career
Licensing & Education
Driver's Licenses
License No.
License Type
State
Expiry Date
Years Held
Add
Remove
RTA /Vic Roads Driver's History
Sighted by
Copied and put on file
Yes
Do you hold any safe driving awards?
Yes
No
If yes, please provide details
Have you ever been charged with a criminal offence?
Yes
No
If yes, give full details below
Have you ever been charged with any of the following offences during the past 5 years?
If yes, give full details below:
Driving under the influence of any drug
Yes
No
Driving under the influence of alcohol
Yes
No
Dangerous driving
Yes
No
Culpable driving
Yes
No
Negligent driving
Yes
No
Date
DD slash MM slash YYYY
Offence
Court Findings
Date
DD slash MM slash YYYY
Offence
Court Findings
Date
DD slash MM slash YYYY
Offence
Court Findings
Accident History
Please provide full details of any vehicle accident in which you have been involved in the last five years:
Date of Accident
Time of Accident
Name of Employer
Nature of Accident
Approximate Cost of Repairs
Add
Remove
Declaration
Consent
*
I hereby declare that the above particulars are true and correct and that I have not withheld or suppressed any information concerning the above particulars.
*
Consent
*
I agree that, upon request, I will provide a complete and up to date record of my driving history from the responsible authority in the State or Territory.
*
Consent
*
In the event of employment, I understand that false or misleading information given in my application or interview or any other employment process may result in termination of employment.
*
Consent
*
I also understand that I am required to abide by all policies, procedures and rules of the company.
*
Consent
*
I understand that if I am successful in gaining a position with the company it will be for a qualifying period of 90 days from commencement of employment during which time my performance can be terminated at any time.
*
Consent
*
I also understand that the qualifying period may be extended for a further 90 days at the employer's discretion.
*
Signature of Driver
*
Date
*
