Candidate Registration

Languages Spoken
English, Dutch and German
Can you read and write English
Yes
Do you have a Driver's Licence
No
What is your Driver's Licence class?
N/A
What is your Driver's Licence Number?
8255689
Do you have a car to get to and from work regularly?
No
Job Seeker ID Number
N/A
Job Network
N/A
Are you right-handed or left-handed?
Right Handed
Please note your payslips will be delivered electronically
What is the name of your usual Medical Practitioner?
Fremantle Family Doctors
What is the address?
283 South St, Hilton WA 6163
Contact Telephone Number
0893141999
Are you prepared to undergo a Drug and/or Alcohol Analysis/Testing, either random or
scheduled?
Yes
Are you prepared to undergo a Pre Employment Medical Examination?
Yes
High Blood pressure
No
Treatment / Medication (High Blood Pressure)
N/A
High Cholesterol
No
Treatment / Medication (high cholesterol)
N/A
Stroke / Brain Aneurysm
No
Treatment / Medication (Stroke/Brain Aneurysm)
N/A
Blood Disorder
No
Treatment / medication (blood disorder)
N/A
Heart Condition (incl. Heart attack, chest pain or myocardiopathy)
No
Treatment / Medication (Heart condition)
N/A
Anxiety / Depression
No
Treatment / Medication (anxiety/medication)
N/A
Lethargy / Fainting / Seizures / Blackouts
No
Treatment / Medication (lethargy/fainting/seizures/blackouts)
N/A
Back Pain or Sciatica
No
Treatment / Medication (back pain or sciatica)
N/A
Asthma / Bronchitis or other respiratory disorder
No
Treatment / Medication (asthma/bronchitis)
None
Diabetes Type 1 or Type 2
No
Treatment / Medication (diabetes type 1 or type 2)
N/A
If yes to Diabetes, are you currently taking medication?
N/A
Epilepsy / Paralysis
No
Treatment / Medication (epilepsy/paralysis)
N/A
HIV / Hepatitis
No
Treatment / Medication (HIV/Hepatitis)
N/A
Chronic Fatigue Syndrome, Ross River, Virus, Lyme's Disease or Rheumatism
No
Treatment / Medication (Chronic Fatigue syndrome, Ross River Virus, Lyme's Disease or
Rheumatism)
N/A
Tennis Elbow or Repetitive Strain Injury
No
Treatment / Medication (tennis elbow or repetitive strain injury)
N/A
Varicose Veins
No
Treatment / Medication (Varicose Veins)
N/A
If diabetic are you managed by a GP or Endocrinologist and what was the date of your
last visit
No
Hernia
No
Hernia - Please specify type
No
Treatment / Medication / Type (hernia)
N/A
Sight impairment - do you wear glasses for reading or driving
Yes
Treatment / Medication (sight impairment)
Prescription glasses / contact lenses
Any broken bones in the last 10 years?
No
If yes to broken bones, did you require any pins or plates and are they to be removed or
permanent
N/A
Cancer or tumours, please specify
No
Treatment / Medication (cancer or tumours)
N/A
Other
N/A
NOTE: Failure to declare known medical conditions could result in your application
being cancelled and incurring medical costs
Are you contemplating having any medical or surgical treatment in the future?
No
Provide Details (medical treatments)
N/A
Are you aware of any medical conditions that may prevent you from performing the
duties of the position to which you are applying?
No
Provide details of any medical conditions that may prevent you from performing the
duties of the position to which you are applying?
N/A
Do you have any medical conditions which may prevent you from wearing approved
personal protective safety equipment including (but not limited to) steel cap safety
boots, eye protection, ear protection, hard hats, safety vests, safety harness?
No
Provide details (do you have any medical conditions which may prevent you from
wearing approved personal protective safety equipment)
N/A
Are you currently using any regular medication, prescribed or un-prescribed?
No
Provide details (are you currently using any regular medication, prescribed or
unprescribed)
N/A
Are you allergic to anything?
No
Provide Details (Are you allergic to anything)
No allergies
Have you ever had any Workers' Compensation claim or any work related illness or
injury?
No
Date (Workers Comp Claim)
N/A
Injury(works comp)
N/A
Employer(workers comp)
N/A
Insurance company(workers comp)
N/A
Are you currently using any regular medication, prescribed or un-prescribed?
No
Provide details (Are you currently using any regular medication, prescribed or un-
prescribed)
N/A
Do you smoke?
No
how many per day
N/A
Do you declare that the above information provided concerning your state of Health is
true and complete, and that no information has been withheld or omitted
Yes
Do you understand that the information you have provided in this Health Assessment
Section will only be used to assist Sure People Solutions in the prevention of workplace
injuries and illness and for the purpose of meeting OHS obligations. The information
you provide will be kept in strict confidence, although in cases where the information
must be disclosed to the owner of premises where you are placed to work for the
purpose of managing OHS obligations, the relevant information will be released to them
for that purpose only and in the strictest confidence. Sure People Solutions advises that
it will only use the information you provide for necessary purposes in accordance with
Privacy Laws, Anti-Discrimination Legislation and OHS Laws.
Yes
Do you understand that if you are accepted for employment and that if any information
is found to be false or misleading or any material facts are suppressed, it may lead to
the termination of your Contract or your Contract will be terminated?
Yes

Neck
Did this interfere with your ability to work? (Neck)
Not at all
How uncomfortable was this? (neck)
Not Applicable
Any back / spine disorder including Neck (Whiplash); Back / Neck Fusion
No
Treatment / Medication (any back/spine disorder including neck/back)
N/A

Right Shoulder
Did this interfere with your ability to work? (right shoulder)
Not at all
How uncomfortable was this? (right shoulder)
Not Applicable
During the last week, how often did you experience ache, pain or discomfort in your
right shoulder?
Never

Left Shoulder
Did this interfere with your ability to work? (left shoulder)
Not at all
During the last week, how often did you experience ache, pain or discomfort in your left
shoulder?
Never
How uncomfortable was this? (left shoulder)
Not Applicable
Upper Back
Did this interfere with your ability to work? (upper back)
Not at all
During the last week, how often did you experience ache, pain or discomfort in your
upper back?
Never
How uncomfortable was this? (upper back)
Not Applicable

Right Upper Arm

Did this interfere with your ability to work? (right upper arm)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right upper arm?
Never
How uncomfortable was this? (right upper arm)
Not Applicable

Left Upper Arm

Did this interfere with your ability to work? (left upper arm)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
left upper arm?
Never
How uncomfortable was this? (left upper arm)
Not Applicable

Lower Back
Did this interfere with your ability to work? (lower back)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
lower back?
Never
How uncomfortable was this? (lower back)
Not Applicable

Right Forearm and Elbow

Did this interfere with your ability to work? (right forearm and elbow)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right forearm or elbow?
Never
How uncomfortable was this? (right forearm and elbow)
Not Applicable
Did this interfere with your ability to work? (left forearm or elbow)
Not at all

Left Forearm and Elbow

During the last week, how often did you experience aches, pain or discomfort in your
left forearm or elbow
Never
How uncomfortable was this? (left forearm or elbow)
Not Applicable

Left Wrist
Did this interfere with your ability to work? (left wrist)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
left wrist
Never
How uncomfortable was this? (left wrist)
Not Applicable

Right Wrist
Did this interfere with your ability to work? (right wrist)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right wrist
Never
How uncomfortable was this? (right wrist)
Not Applicable

Hips/Buttocks
Did this interfere with your ability to work? (hips/buttocks)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
hips/buttocks?
Never
How uncomfortable was this? (hips/buttocks)
Not Applicable

Right Thigh
Did this interfere with your ability to work? (right thigh)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right thigh
Never
How uncomfortable was this? (right thigh)
Not Applicable
Left Thigh
Did this interfere with your ability to work? (left thigh)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
left thigh?
Never
How uncomfortable was this? (left thigh)
Not Applicable

Right Knee
Did this interfere with your ability to work? (right knee)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right knee?
Never
How uncomfortable was this? (right knee)
Not Applicable

Left Knee
Did this interfere with your ability to work? (left knee)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
left knee?
Never
How uncomfortable was this? (left knee)
Not Applicable

Right Lower Leg

Did this interfere with your ability to work? (right lower leg)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right lower leg?
Never
How uncomfortable was this? (right lower leg)
Not Applicable

Left Lower Leg

Did this interfere with your ability to work? (left lower leg)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
left lower leg?
Never
How uncomfortable was this? (left lower leg)
Not Applicable
Right Foot & Ankle
Did this interfere with your ability to work? (right foot and ankle)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
right foot and ankle?
Never
How uncomfortable was this? (right foot and ankle)
Slightly uncomfortable

Left Foot & Ankle

Did this interfere with your ability to work? (left foot and ankle)
Not at all
During the last week, how often did you experience aches, pain or discomfort in your
left foot and ankle?
Never
How uncomfortable was this? (left foot and ankle)
Not Applicable
Have you obtained work through a Labourer Hire/Recruitment Company before?
Yes
Which Company and When?
Evolve Talent — February 2022
Have you worked for Sure People Solutions before?
No
Please list which branch and when
N/A
Have you ever been convicted of a criminal offence?
No
Are you currently, on Bail, Parole, Good behaviour bond, Police watch list etc?
No
Are there any legal restrictions which may prevent you from performing your duties in
this position? if yes please specify
No
Do you have any pets? If so how many & what are they?
No pets
What sports/exercise do you actively participate in?
Yoga, Pilates, gym, running and hiking
Where did you hear about Sure People Solutions?
Through a friend
Any other points or information I would Like to add?
N/A

UNIFROM REQUIREMENTS
(Please provide details below, even if no uniform is required)

Pant Size
8
Shirt Size
8
Shoe Size
40 EUR

REIMBURSEMENT AUTHORISATION
I agree to pay, in full, the costs of any of the following too Sure People Solutions (SPS)
within seven (7) days by debit, funds transfer OR cheque (made payable to Sure People
Solutions) as per below;

1. I will reimburse all costs to SPS for my Drug & Alcohol Test, if my test results come
back positive to medications without prescribed or illegal substances that would
inhibit/prevent me; to either commence or carry out the job assignment with SPS
or SPS's client.
2. I will reimburse SPS for my flight to and/or from site, if I do not make my flight on
time without advising SPS or Host Employer 48 hours before flight that I am unable
to make my flight.
3. I will reimburse SPS for my flights to and from site, if I test positive to a Drug and
Alcohol test when I arrive on site and have to catch the next available flight back
to Perth.
4. I will reimburse to SPS part/full costs for uniforms & training courses provided to
me, in instances where I choose to either leave/quit a position where I am currently
working.
5. If my application in obtaining work is successful, I.e. SPS & client have offered me
the position & I choose not to accept the position. I acknowledge & accept that I am
liable for any medical costs that have occurred. I accept that the medical report will
be provided to me once I have paid the account.

I agree to all of the above conditions.

Sure People Solutions will keep a copy of this authorization form for my records. I can
receive a copy of this agreement upon request.
If I am responsible for reimbursing Sure People Solutions for any of the above, SPS will
provide me with a copy of the invoice/receipt to showing the full amount that's due to
them. I will pay in full within seven (7) days of receiving an invoice from SPS.
CASUAL/TEMPORARY EMPLOYEE AGREEMENT

This Temporary Employee Agreement is to be signed by all Casual/Temporary staff

upon registering for employment with Sure People Solutions Pty Ltd ABN 32 135 806
950 (herein referred to a SPS).
After you have signed this Temporary Employment Agreement we will place you on our
register.

We will keep you on our register unless:

(a) We don't hear from you for 12 months;

(b) You advise us you are no longer interested in seeking work; or

(c) You ask us to remove your details from the register.

Please read this form carefully and then sign it to confirm your understanding of the
terms and conditions of your temporary employment. I have read, understood and agree
to the conditions set out below:
1. My employment with SPS is as a temporary/casual employee on an assignment by
assignment basis, with each assignment constituting a discrete period of employment.
2. I acknowledge that as a casual/temporary employee, I am paid a loading in lieu of all
leave entitlements.
3. I am aware that I am expected to faithfully serve SPS during each assignment and to
perform such duties as I am reasonably and lawfully directed. I acknowledge that from
time to time I may be asked by SPS to serve and perform duties for SPS Related
Companies and agree that this is within the scope of my employment relationship with
SPS. For the purpose of this clause, Related Company has the same meaning as in the
Corporations Act 2001.
4. I am aware that when one of SPS's clients requests the supply of an employee to
perform an assignment, SPS will consider whether I am suitable to do the type of work
requested. If SPS considers that I am suitable to perform the work, SPS may offer to
employ me for the assignment.
5. I am aware that in determining whether I am suitable to do the type of work requested,
SPS may be required to carry out a criminal record check to meet the needs of SPS's
client. I agree to sign the necessary paperwork to allow a criminal record check to be
carried out where it is required for a particular assignment.
6. I may accept or reject any offer of an assignment from SPS.
7. I acknowledge that each time I accept a new assignment; I am entering into a new
contract of employment with SPS. The terms of those contracts will include the rights
and obligations that apply to assignments as set out in this agreement.
8. In accepting an assignment, I promise that: a. I possess the skills, experience and
qualifications set out in my resume or the forms I complete in registering for
employment with SPS;
b. I am lawfully entitled to work in Australia;
c. my level of health and fitness is suitable for the performance of the genuine
occupational requirements of the Assignment; and
d. I have undergone or will undertake an induction program relevant to assignments
that I may be offered and that I will not undertake assignments unless I fully understand
all components of the induction programme.
9. On completion of an assignment, whether satisfactory or otherwise, SPS is under no
obligation to offer me further assignments.
10. I understand that SPS does not control the length of any assignment and I accept
that whilst SPS may indicate the potential length of an assignment with a client in good
faith, the client may vary the length of an assignment period or terminate my attendance
at an assignment at their absolute discretion.
11. I accept that if a client of SPS varies the length of any assignment, or terminates my
attendance at an assignment in accordance with clause 6 above, SPS has the right to
end my employment as it relates to that assignment. Where notice of termination is
required, such notice will be the minimum notice required by law. I accept that SPS may
elect to pay me in lieu of notice and end my assignment immediately.
12. This agreement applies independently of the provisions of any Award or industrial
agreement that might relate to any Assignment to which I may be allocated, and does
not incorporate its terms. SPS does verify that all FWA, & EBA Agreements are
complied with & that relevant information pertaining to these Agreements will be made
available to Casual employees where ever applicable
13. I accept that I am under the care, control and supervision of SPS's client during the
period of any assignment in regard to defined working arrangements and the manner
and proficiency in which my work is to be performed. I undertake to perform the tasks
required of me in a conscientious and competent manner. I acknowledge the right of
SPS's client to direct my work activities.
14. I agree to adhere to all Occupational Health and Safety policies & other policies and
procedures of SPS and SPS's client and to obey all lawful and reasonable orders of
SPS's clients with regard to the use of safety equipment, the wearing of protective
clothing and noise protection devices and with regard to methods of performing work
tasks
15. I am aware that some SPS & its clients carry out drug and alcohol testing in their
workplaces and that I may be subject to such testing while working in such a workplace.
16. I accept that on some types of assignments I may be required to undertake a
medical examination and/or hearing test. If such tests are required, I authorize the
results of those tests to be made available to SPS and its client.
17. SPS is responsible for statutory workers compensation insurance and in the event
of any injury occurring during an assignment, I will contact SPS with details
immediately.
18. Payment for my work will be made by SPS on a weekly basis only upon receipt of a
SPS timesheet, correctly completed and with appropriate authorization by an approved
client supervisor, or by some other method defined by SPS. I understand that I will not
receive payment for work done until SPS has receipt of that timesheet.
19. Payment to me by SPS may be made by Electronic Funds Transfer to the bank
account nominated by me or by cheque, at the discretion of SPS.
20. I agree to complete an Employment Declaration (Australian Taxation Office) form
with SPS this financial year if I have not already done so. I accept that SPS cannot pay
me unless I have delivered a completed Employment Declaration form to a SPS branch.
21. My remuneration by SPS may be on an hourly basis. I acknowledge that should an
award, agreement or other industrial instrument be applicable to the assignment, I will
be paid in accordance with that award, agreement or industrial instrument.
22. I acknowledge that SPS will often incur costs in regards to Medicals, inductions,
uniforms etc. to ensure suitability of myself as a candidate. I agree to repay these cost
back to SPS if & where instances occur that I have either been accepted as successful &
yet turn the position down, where my medical results have deemed myself unfit, or
where I fail a medical. I will repay the costs to SPS in full.
23. I acknowledge that in the absence of an appropriate award, agreement, or other
industrial instrument, my remuneration is on an hourly basis at the rate agreed between
SPS, the client & myself. I understand that this rate will be inclusive of annual leave, all
personal leave or any other relevant legislative entitlements unless notified otherwise.
24. I agree that I will not discuss nor disclose my hourly rate of pay to any SPS
temporary employee, other agency staff or any of SPS's clients. My rate of pay is
confidential and I will only discuss this with a Consultant from SPS.
25. Occupational Superannuation will be paid in accordance with the appropriate
legislation.
26. I understand that future payments may be adjusted if actual working hours or other
details differ from information provided on authorized timesheets received by SPS and
by signing this Agreement I specifically agree to allow SPS to deduct any over payment
from my future payments.
27. I agree to notify the SPS office as soon as practicable, but no later than one hour
before normal start time on any day, that I am unable to attend during any period of an
assignment.
28. I acknowledge that during the period of my assignment I will have access to and
become familiar with information which belongs to SPS's client and has commercial
value to SPS's client. This may include but not be limited to particulars of the client,
plans, operations and procedures, management policies, production techniques,
financial arrangements and computer media
29. I will not disclose any Confidential Information directly or indirectly or use any
Confidential Information either during the period of employment or at any time
afterwards except as required in the course of an assignment and as authorized by
SPS's client.
30. I acknowledge that all files, records, documents, discs, equipment and similar items
relating to the business of SPS s clients, whether prepared by me or not, remain the
exclusive property of SPS's clients.
31. For a period of six months from the cessation of my last assignment, I agree that I
will not accept a direct offer of employment whether temporary, contract or permanent
from any client or former client of SPS to whom I am introduced by SPS without first
notifying SPS.
32. During my employment with SPS and for a period of three months from the
cessation of my last assignment, I agree that I will not seek nor accept a direct offer of
employment from another agency for an assignment or placement, whether temporary,
contract or permanent, with a client of SPS, if I have been introduced to that client by
SPS.