Position:	*
Email:	*
Surname:	*	First Name:	*
Street Address:	*
Suburb:	*	Postcode:	*
Home:		Mobile:
Business:

Date of Birth:

/

/

Secondary School:
Secondary Qualifications:
Other Qualifications:

Last 3 Jobs:

1.	Current/Last Job

Employer:
Period of Employment:
Reason for Leaving:
Duties:

2.	Second Last Job

Employer:
Period of Employment:
Reason for Leaving:
Duties:

3.	Third Last Job

Employer:
Period of Employment:
Reason for Leaving:
Duties:

Unemployment:

Detail any periods of unemployment over the last 6 years

From:		To:
From:		To:

Marital Status:

Married

Single

De facto

Details of Dependant Children:
What skills do you have to offer?

Yes

No

Details:

Have you ever been convicted of an offence under any Act?
Are you a permanent resident of Australia and legally entitled to work in Australia on full time basis? Photo ID and Evidence of Citizenship and visa status required
Have you ever made a Work Cover, Work Care or Work Comp Claim?
Have you ever been summarily dismissed?
Do you have any pre-existing injuries, disease or condition, which may be affected by the duties involved in carrying out the position. Failure to disclose this may affect future Workcare claims.
Have you had any Judgments taken out against you in the last 5 years?
How many sick days have you claimed in your last 24 months of employment?		DAYS
Have you ever been bankrupt?

	Yes	No
Have you ever applied for a position with this company before?
Do you have experience in environments with specific performance goals?
Please list the software applications you can comfortably and proficiently use.
What are your top five skills?
What functions do you perform on a regular basis in your past position/s? what percentage of your time do you spend on them?
Please indicate the number of year’s experience you have in customer service.
1-3 years 3-6 years 6 -10 years 10 or more
Please indicate your level of experience in monitoring customer complaints?
Describe a time when you solved a problem for a customer but the customer was not happy with the solution. How did you handle the situation?
Please describe a situation where you were required to solve a complaint from a customer. Describe the process undertaken and the final result.

	Yes	No
Have you read the job description?
Attach your Personal Resume
I confirm that the information provided is true and correct and may be relied upon by Prushka in making a decision to offer me employment.

Signature:

*

Date:

/

/

*