Candidate Name:

Candidate WorkDesk Code:

Candidate Registration Form

By completing and signing this registration booklet, you are consenting to SCO Recruitment performing background checks. Offers of employment may be subject to a medical examination, working with children’s checks, AFP Criminal Records Check and other background check which may include and academic qualifications check, certification check, reference check or any other check deemed relevant to the position/s you are applying or put forward for. Please note, applicants may be required to undertake a medical examination as part of the employment application process, which may include testing for alcohol and other drugs to ensure that duties can be performed safety and adequately. All information contained within this application will be treated as confidential under The Federal Privacy Act 1988.

SCO RecruitmentUnit 5, 333-335 Newbridge Road Moorebank NSW 2120 P.O Box 748, Moorebank NSW 1875

T: 9824 3279 F: 9824 3051

OFFICE USE ONLY

www.scorecruitment.com.auABN: 64 137 038 709

CANDIATE INFORMATION - Temporary/Casual Positions

POSTION REQUIRED

What type of work are you seeking?

APPLICANT DETAILS (Use Block Letters)Title: Mr. Ms. Mrs.

Date of Birth: Marital Status: (Optional)

First Name: Surname:

Address:

Suburb: Post Code:

Email:

Telephone: Mobile:

EMERGENCY CONTACT DETAILS (Use Block Letters)

Full Name:

Telephone: Mobile:

Relationship:

AVAILABILITY (Use Block Letters)

Are you eligible for employment in Australia? YES NOPlease note proof of eligibility is required

Are there any Visa restrictions that may affect your ability to work in Australia? YES NOIf YES please describe below

Drivers Licence: C R LR MR MC HR HC No Licence

Licence Number: Do you have your own transport? YES NO

Days Available: Mon Tues Wed Thurs Fri Sat Sun

Hours Available:

What Time can SCO call you for work?

Notice required in current position?

Time prepared to travel to and from work?

Area prepared to travel to and from work? City Inner West East West North South

Minimum Hourly Rate Required:

ADDITIONAL INFORMATION:

Do you wish to identify yourself as an Aboriginal/Torres Strait Islander? YES NO

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Do you reside in Government or Community Housing? YES NO .

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EMPLOYMENT HISTORYPlease describe your employment history, listing the most recent position first.

Employer Position Dates Primary Duties Reason for Leaving

REFERENCES*Please provide three (3) work related references.If you have no employment history, personal references will be accepted

Company Position Contact Person Contact Number

QUALIFICATIONS / LICENCESPlease list any qualification, tickets and/or professional licences you hold.

Qualification / Ticket / Licence Institution / Issuer Year Completed / Received

*Please note that by providing this information you are consenting to SCO Recruitment to conduct reference checks.

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A BIT ABOUT YOU

Please tell us why you would be a good candidate to represent SCO Recruitment at our client sites?

What do you consider to be your strengths?

Is there any other information you wish to advise us about your suitability or candidature?

EMPLOYEE PAYROLL INFORMATION“Please note SCO Recruitment has a number of companies that operate in the same group and you may receive multiple PAYGW summaries (Group Certificates)”

BANK ACCOUNT DETAILS:

Name on Account:

Name of Bank:

Branch Location:

BSB Number: (6 digits)

Account Number: (Not the number on your ATM card)

SUPERANNUATION DETAILS

I have supplied SCO Recruitment with my own super fund membership details?

I have selected SCO Recruitments’ default super fund – CARE SUPER? I have completed the Choice of Superannuation Fund Standard Choice Form?

How did you hear about SCO Recruitment?

SEEK My Career

Local Newspaper Please specify Google

SCO Candidate Please specify Daily Telegraph

SCO Client Please specify Facebook

Other Please specify Sports People

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EMPLOYEE HEALTH QUESTIONNAIRE

Your answers to these questions are important in enabling SCO to place you in work that, as far as practicable, does not place you at risk of injury and to identify actions that may be required to make the job safer for you.

You must answer the questions truthfully and to the best of your knowledge. The information you provide will be treated as confidential and its access limited to a “need to know” basis. Please note that providing false or misleading information is a chargeable offence - answer ALL questions honestly. If you have difficulty answering any question/s, please ask your consultant for assistance. After you have completed the questionnaire, please sign where indicated and hand back to the consultant.

HEALTH

1. Do you suffer from asthma or a dry cough? (Please specify) YES NO

2. Do you suffer from skin rashes, eczema or dermatitis? (Please specify) YES NO

3. Are you able to wear safety equipment such as boots, glasses and helmets? YES NOIf “NO” please explain why:

4. Do you wear or have worn orthotics? YES NO

5. Do you or have you suffered from a reaction to any chemicals? YES NOIf “YES” which chemicals:

6. Do you suffer or have you suffered from ringing in the ears or hearing loss? (Please specify) YES NO

7. Do you have vision problems that are not corrected by prescription glasses or contact lenses?e.g. blurred vision, glare, dazed by lights? (Please specify) YES NO

8. Have you ever been diagnosed with a heart condition? YES NO

9. Have you ever had a mental illness (e.g. anxiety, depression, bipolar disorder)? (Please specify) YES NO

10. Do you experience sudden attacks of giddiness, fainting or blackouts? (Please specify) YES NO

11. Do you smoke? YES NOIf “YES” what and how much?

12. Do you drink alcohol, if so how many standard drinks per week? YES NO

13. Do you suffer from arthritis, rheumatism, joint pain or swelling? (Please specify) YES NO

14. Have you ever been diagnosed or do you suffer with Repetitive Strain Injury? YES NO

15. Do you suffer or have you suffered from back or neck pain? (Please specify) YES NO

16. Do you have full range of movement of all joints (e.g. knee, elbow, shoulders)? YES NO

17. Have you had a back or neck x-ray or scan? (Please specify) YES NO

18. Do you suffer or have you suffered from epilepsy? YES NO

19. Do you have any other condition that could impact your work, your safety or that of others?If “YES” please provide details below: YES NO

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20. Have you ever suffered injuries as a result of the use of a motor vehicle, motor cycle or bicycle? If “YES” please specify type of injury and approximate date: YES NO

Type: Date:

21. Do you use illicit drugs? If “YES” which drugs, how often, and how much? YES NOIf “YES” please specify the type and approximate date:

22. Have you ever had any operations? YES NO

If “YES” please specify the type and approximate date:

Type:

Date:

WORK HISTORY

23. Have you ever worked with any substances that may have been hazardous to your health? If “YES” please list which substances: YES NO

24. Have you ever worked in a noisy environment? YES NOIf you answered “YES” to both the questions above please list your previous employer

Employer/s:

Position:

Dates worked:

25. Have you worked in a position that required repetitive work? YES NOIf you answered “YES” to both the questions above please list your previous employer/s:

Employer/s:

Position:

Dates worked:

GENERAL

26. Do you object to a breathalyser or drug test? YES NO

27a.Do you have any current or ongoing Workers Compensation Claim(s)? YES NO

If “YES” please detail and answer Question 28b:If “NO” go straight to Question 29:

27b. Was a Medical Certificate issued for a return to full duties for the above Workers Compensation Claims?If NO, please supply details: YES NO

28. Have you ever had a Workers Compensation Claim? YES NO

a. If YES then when and against whom?

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b. What was the result of the claim?

c. Date of Injury?d. Number of claims in the past 10 years?

29. Do you have any medical conditions or take medication for any medical condition? YES NOIf “YES” please detail:

WORK ENVIRONMENT & ACTIVITIES

Do you have any difficulty in performing the following activities?

30. Working in hot environments? YES NO

31. Working in cold environments? YES NO

32. Working at heights? YES NO

33. Sitting for long periods? YES NO

34. Climbing ladders? YES NO

35. Standing for long periods? YES NO

36. Crouching? YES NO

37. Kneeling? YES NO

38. Reaching above shoulder height? YES NO

39. Repetitive lifting? YES NO

40. Writing? YES NO

41. Being transported? YES NO

Please list anything else that may affect you or your work colleagues:

DECLARATION

I hereby declare all information supplied in this Health and Safety Declaration to be true and correct to the best of my knowledge. I understand that if I have given false or misleading information that I will be liable for dismissal without notice.

If engaged by SCO Recruitment I agree to wear hearing or other PPE (Personal Protective Equipment) and/or clothing as required by SCO Recruitment or its Client’s in accordance with statutory requirements or Company/Clients policy.

Candidate Full Name:(Please Print)

Candidate Signature: Date:

SCO Consultant Signature:

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FORM OF DISCLOSURE PRE-EXISTING INJURIES

Pursuant to the Workers Compensation Act 1987 (NSW) it is requested that you disclose any pre-existing injuries suffered by you, of which you are aware, and which could be affected by the nature of the proposed employment offered to you.

I declare that I am aware of the following pre-existing injuries: Injury Details:

Insurance Company Details:

Employer Details:

OR; I have no such pre-existing injuries (please tick)

Candidate Full Name:(Please Print)

Candidate Signature: Date:

The Workers Compensation Act 1987 will apply to a failure to make such a disclosure or the making of a false or misleading disclosure.

If this section applies, any recurrence, aggravation, acceleration, exacerbation or deterioration of the pre-existing injury and or disease arising out of or in the course of or due to the nature of employment with the employer does not entitle the worker to compensation under the Act.

Any information provided on this form will be used for the purpose of the Act only.

CONFIDENTIALITY AGREEMENT FOR CASUAL (TEMPORARY) STAFF;

I understand by accepting an assignment and engaging as a Spectrum Casual Employee to perform that assignment that I will not during my employment or thereafter, without Spectrum’s prior written consent or as otherwise required by law, disclose directly or indirectly to any person for any reason other than for the proper conduct of Spectrum’s or any Spectrum’s customer’s business any trade secrets or confidential information that may come to my notice during the course of your employment.

Nor will I during my employment or thereafter without Spectrum’s prior written consent or as otherwise required by law use any part of Spectrum’s or any Spectrum’s customer’s trade secrets or confidential information other than as required in the proper performance of my duties.

Formally noted and accepted:

Candidate Name: Witness Name:

(Please Print)

Signature: Signature:

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Date: / / Date: / /

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CONSULTANT NOTES:

Interviewed By: Date:

OFFICE USE ONLY

CONSULTANT NOTES:

Interviewed By: Date:

OFFICE USE ONLY

Completed By: Signed: Date: _____________

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Bank Account Details Entered Super Form sent to Fund Manager

Completed Allowances & Deductions Screen Superannuation Fund Details Entered MUST be defaulted to Care if other not provided)

HELP Debts checked (if applicable) Tax File Declaration sent to ATO

Completed Taxation Screen TFN Received & Correct TFN Confirmed Threshold Tax Scale Entered

Entered Bank Account Details Bank Details Confirmed with Bank Updated status entered into WorkDesk 10

Candidate Entered in Relevant Group/s Completed Main Screen

(Including; cost category, commencement date)

Completed By: Signed: Date: _____________

3. WORKDESK EMPLOYEE RECORD

Entered in Consultant Comments Availability and Travel Job and Job Condition Preferences Restrictions PPE/Tickets/Licences/Qualifications Suitability i.e. Client/Job Type Communication/Presentation OHS Outcomes Reference Check Outcomes Additional Consultant Notes

Correct Candidate Code Correct Address and Contact Details Skill Code Entered Next of Kin/Emergency Contact Employment History Entered TFN/Bank Details Entered Interviewed By Consultants Notes Entered

Completed By: Signed: Date: _____________

2. WORKDESK CANDIDATE RECORD

Accepted Rejected

Working with Children Check Completed Working with Children Check Submitted Written Confirmation Received

DIMIA Check Submitted – Copies MUST be included in File YES Visa End Date: ____________ NO Reason if No: ____________ Not Required

If Applicable: Working with Children Checks - Confirmations MUST be included in file

Completed Choice of Super Fund Form Completed Qualifications and Licences License copies provided i.e. drivers/forklift Completed Confidentiality Agreement Completed Disclosure of Pre-Existing Injuries Completed Skill Codes/ Matching Form Fully Completed Wrap x2 Reference Checks Completed

Completed Candidate Information Photo Identification Provided Proof of Work Rights Provided Resume Provided Completed Tax File Declaration Completed Work History and References Completed Employee Health Questionnaire Completed OHS Video and Questionnaire

CANDIDATE DATA INTEGRITY

All candidate files must contain this Checklist. All boxes must be checked or marked N/A. Sections 1 and 2 must be completed prior to filing as a candidate. A candidate must not commence work unless these sections are complete. Section 3 must be completed immediately when the candidate commences work as an employee with SCO.

1. CANDIDATE WRAP