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Registration Form
PERSONAL DETAILS
Family Name:
*
Given Name:
*
Residential Address:
*
Postal Address:
Phone:
*
Mobile:
E-mail:
*
Country Of Birth:
*
Date Of Birth:
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
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Year
1932
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2007
Do you hold a current Driver Licence?:
*
Yes
No
Do you have your own transport?:
*
Yes
No
Are you an Australian citizen?:
*
Yes
No
If you are not an Australian citizen, are you a permanent resident?:
Yes
No
Are you of Aboriginal or Torres Strait Islander origin?:
*
No
Aboriginal
Torres Straight Islander
Do you speak a language other than English at home?:
*
Yes
No
IF YES: PLEASE SPECIFY:
How well do you speak English?:
VERY WELL
WELL
NOT WELL
NOT AT ALL
POSITIONS OF INTEREST
1.:
2.:
WORK EXPERIENCE
Have you ever worked in the construction industry?:
*
Yes
No
What trade?:
Duties:
EDUCATION
What is your highest completed school level?:
*
What year did you last attend school?:
*
Have you completed any further studies since leaving school?:
*
Yes
No
IF YES: PLEASE INDICATE BELOW:
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma (or Associate Diploma)
Certificate IV (or Advanced Certificate/Technician)
Certificate III (or Trade Certificate)
Certificate II
Certificate I
Certificates other than the above
Qualification Title:
Have you previously worked as an apprentice or trainee?:
*
Yes
No
IF YES: PLEASE DETAIL BELOW:
Have you completed an OHS induction card (‘white card’)?:
*
Yes
No
IF YES: PLEASE PROVIDE YOUR REGISTRATION NUMBER BELOW:
HEALTH
Have you had, or do you suffer, from:
Asthma:
*
Yes
No
Dermatitis:
*
Yes
No
Epilepsy:
*
Yes
No
High blood-pressure:
*
Yes
No
Limb injuries:
*
Yes
No
Chronic illness:
*
Yes
No
Diabetes:
*
Yes
No
Heart complaint:
*
Yes
No
Back injury:
*
Yes
No
Other:
*
Yes
No
Do you consider yourself to have a permanent or significant disability?:
*
Yes
No
Do you require assistance because of this disability?:
Yes
No
Are you on medication that may affect your work?:
*
Yes
No
Have you had any serious illnesses or operations in the last two years?:
*
Yes
No
If you answered “YES” to any of the above questions, please provide details::
GENERAL
Why do you want an apprenticeship in construction?:
*
Why do you want to work for CITEA?:
*
What are your hobbies or sports interests?:
Are you prepared to abide by the Occupational Health and Safety rules and regulations relating to the construction industry?:
*
Yes
No
Do you have any objection to CITEA seeking verification or additional information regarding this application?:
*
Yes
No
Would you be prepared to work overtime and weekends if required?:
*
Yes
No
If you were offered a position with CITEA, when could you start?:
*
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Math question:
*
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Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
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