THIS APPLICATION MUST BE COMPLETED AND RETURNED TO

DIAB ENGINEERING PTY LTD BEFORE ANY WORK CAN BE COMMENCED EMAIL: hr@diabeng.com.au

EMPLOYMENT APPLICATION FORM
APPLICANT’S LAST NAME:		Enkh-orshih Narangarav Engineer 2016.10.7
APPLICANT’S FIRST NAME:		Narangarav Narangarav Engineer 2016.10.7
Position applied for:		Engineer
Date of application:		2016.10.7
APPLICANT’S DECLARATION
I understand, and agree, to the following: 1.   That an offer of employment is subject to accepting the terms and conditions of the Diab Engineering Pty Ltd Employee Enterprise Agreement. 2.   That a copy of the Employee Enterprise Agreement and “Fair Work Information Statement” will be provided to me, may be downloaded at  www.fwa.gov.au and is also available from the work site, administration office, and on request by email or post. 3.  That if I am considered suitable for employment with Diab Engineering I will be provided with my individual “Confirmation Notice” confirming my employment classification, rate of pay and work site location. 4.  That, upon request, I may be required to provide Diab Engineering with a pre-employment medical, drug and alcohol clearance and a police clearance. 5.  I must observe all Health & Safety Regulations, and Diab Engineering policies. 6.  I may be required to work “reasonable” additional hours. 7.  I may be required to work on locations where I am unable to return to my place of residence each day. 8.  That my employment will be subject to ongoing “fitness for work testing” inclusive of random drug and alcohol testing. 9.   Diab Engineering will collect, record, and retain personal information during the recruitment process, and in the course of my employment. 10. Clients of Diab Engineering may, with the approval of Diab Engineering, be provided with my personal information during the course of my employment; I declare that the information provided by me in this application is complete and accurate. If any information provided by me is deemed by Diab Engineering to be false or misleading, then my application will be withdrawn and if my employment has commenced then my employment may be summarily terminated.
Signature of Applicant:			Date:

SECTION 1. PERSONAL DETAILS

LAST NAME:

FIRST NAME:

MIDDLE NAME:

Enkh-orshih

Narangarav

Residential address:

16-27toot/ 2r khoroo/ bayanzurkh district/ Ulaanbaatar city/ Mongolia

Postal address:

Mobile:

88649774

Home phone:

99242230

Email:

Naraa.narangarav@yahoo.com

Date of Birth:

1997.04.12

Town/Place:

Uwurkhangai

Country:

Mongolia

Nationality:

Mongolian

If Naturalised, date and place:

Are you an Australian resident?

Yes    No        If No, please attach copy of your VISA

Are you Indigenous? (optional reply)

Yes    No

Gnaala Karla Booja

Noongar   Other

Marital status:

Single

Emergency contact name:

Sugarsuren

Relationship to you:

mother

Home phone:

88749774

Mobile:

88679718

Email:

chsugarsuren@yahoo.com

Address of Contact:

13-3/artsad/erdenetolgoi/kharhorin/Uwurkhangai/Mongolia

When are you available to commence employment?

2018

Do you have a current police clearance?

Number:

Date and State or Territory of Issue:

SECTION 2. LICENSES

Please list all licenses held, including drivers & forklift. Attach all copies.

License

License Number

State/Territory

Type

Expiry

SECTION 3. TRADE / QUALIFICATION DETAILS

APPRENTICESHIP:

Trade:

Commenced:

Completed:

Where:

2014

2015

school

Additional information:

SECTION 4. education
TYPE OF SCHOOL	NAME OF SCHOOL	LOCATION	NUMBER OF     YEARS	MAJOR &  DEGREE
High School	2r Secondary school,	Uwurkhangai-Kharhorin, Mongolia	11 yaers	92%
College
Bus. or Trade School
Professional School	Science and Technology University	Ulaanbaatar, Mongolia	4 yaers	3.2

SECTION 5. WORKERS COMPENSATION HISTORY
NOTE: Section 79 of the Worker’s Compensation and Rehabilitation Act 1981 give the Worker’s Compensation Board discretion to refuse to award compensation which would otherwise be payable when it is proved that the worker has, at the time of seeking or entering employment, wilfully and falsely represented themselves as not having previously suffered from a disability, the subject of the claim for compensation. You are required to advise Diab Engineering of any pre existing medical condition or claim.
Employer		Insurer		Injury / Illness						Dates from/to
Additional information: Applicant Signature                                                                                            Date_
SECTION 6. MEDICAL HISTORY
Doctor’s name:	B.Buyankhishig						Doctors Ph:
Doctor’s Address:	Kharhorin, Uwurkhangai
6.1 Medical Questionnaire
Diab Engineering believes that people with certain medical conditions may be at risk of aggravating those medical conditions when working in some areas or sites.  To help Diab Engineering identify and advise, you are asked to complete the questionnaire on the following pages.  This information could be vital in helping render appropriate first aid to you in the case of illness or injury. This information will be stored as a confidential medical record file under strict security and will be available to you, “Diab Engineering’s Treating Officers” (Occupational Health Nurse, Emergency Services Officers, Safety Advisors) and company Doctor. With the exception of a genuine medical emergency, it will not be made available to any third party without your express permission. You are required to update this information should there be any significant change in your health whilst employed with Diab Engineering.
Are you taking any pills or medication?								Yes     No
If yes, have you obtained a “fit for work” medical clearance?								Yes     No
Are you allergic to any medication?								Yes     No
If yes, please provide details below.
Condition			Yes		No	Detail
Major Operations
Major illnesses
Physical Handicaps
Other

Please tick the appropriate box if you have suffered from any of the following illnesses or injuries
Condition	Yes	No	Condition		Yes	No
Childhood asthma		No	Diabetes			No
Asthma/wheezing in last 2 years		No	Liver problems or hepatitis			No
Shortness of breath		No	High blood pressure			No
Bronchitis in last 2 years		No	Do you have a heart pacemaker			No
Persistent cough in last 2 months		No	Heart problems -     angina, abnormal heart valves, heart attack, heart failure			No
Hay Fever		No	Kidney, bladder/urine problems			No
Sinusitis or chronic sinus problems		No	Fits, seizures, blackouts, epilepsy			No
Fear of confined spaces		No	Inability to work underground			No
Dermatitis, eczema or similar allergic skin conditions		No	Dizziness or vertigo			No
Psoriasis – chronic skin condition		No	Persisting headaches or migraine			No
Tennis or golfers or other chronic elbow problems (exclude minor sprains 1-2 days)		No	Head injury with loss of consciousness of more than a few minutes or fractured skull			No
Neck or upper back problems/injury (exclude minor sprains 1-2 days)		No	Do you have problems with eyesight			No
Shoulder problems or injury (exclude minor sprains 1-2 days)		No	Do you wear glasses or contact lenses			No
Serious knee injury – cartilage, cruciate ligament rupture		No	A significant fear of heights or confined spaces.			No
Chronic knee or hip problems		No	Allergy or reactions to  -  Ammonia			No
Low back problems or injury (exclude minor sprains 1-2 days)		No	Allergy or reaction to – Sulfur			No
Attend chiropractor/physiotherapist on regular basis for spinal manipulation		No	Allergy or reaction to other chemicals?			No
Hernia or hernia repair		No	Allergy or reaction to bees			No
Foot problems		no	Any other allergies			No
If you have answered “Yes” to any of the above, please provide additional information below:
Condition	Detail
Do you have a condition that precludes you from wearing PPE and / or safety footwear?				Yes     No
If yes, please provide additional information in the section above and attach medical evidence.
If you are, or have been, a smoker please complete the following:
Are you currently a smoker?				Yes     No
Do you, or have you ever had, a smoking related illness?				Yes     No
If yes, please provide additional information in the section above.
When did you commence smoking?
When did you cease smoking?
Approximately how many (cigs or cigars) / much (grams) per day do you (or did you) smoke?

SECTION 7.  CHECK LIST
TO AVOID ANY DELAYS PLEASE ENSURE THE PAPERWORK LISTED BELOW HAS BEEN FORWARDED TO ADMINISTRATION.
	Employment Application Form (required before employment can commence)
	Bank Details
	Superannuation Choice Form (if approved by Diab Engineering)
	Tax Declaration
	Medical and/or drug and alcohol clearance (if requested)
	Police Clearance (if requested)
	Trade Certificate (if applicable)
	Driver’s Licence (if applicable)
	Other Licenses (if applicable)
	Visa Details (if applicable)
	Additional medical information (if applicable)