Position Applied for: Permanent Part Time Casual Home Base Business

Surname:

Given Names:

Date of Birth: day 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st month January February March April May June July August September October November December year 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1994 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Unit Number: Street Number: Street Name:
Suburb/Town/City: State: NSW QLD VIC ACT SA NT WA TAS Postcode:

Mobile: Phone: Email:

Marital Status: single married defacto separated divorced widowed Number of Children: Accomodation: home owner buying home leasing/renting share accomodation

Current Drivers License: YES NO License Expiry Date: expired cancelled 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 State of Issue: NSW QLD VIC ACT SA NT WA TAS

Have you ever been interviewed by the police for any criminal offence?: YES NO

If you answered YES please provide details below:


Do you suffer from any injury, illness or ailment that will affect your work?: YES NO

If you answered YES please provide details below:


What sports and hobbies are you involved in?:


What renumeration do you expect to earn per annum?: $25,000 > $50,000 $50,000 > $100,000 $100,000 > $250,000 $250,000 > $500,000 in excess of $500,000

Are you interested in becoming your own boss?: YES NO

Please tell us why you have applied for this position?:


What do you believe the position entails?:


Are you prepared to attend PainFree's 3 hour orientation/training session?: YES NO

Are you prepared to attend PainFree's ongoing training sessions?: YES NO

Please tell us why the company should consider you for this position?:


What location are interested in working?: Town/City: State: NSW QLD VIC ACT SA NT WA TAS

Please choose the position you are applying for: Home Base Business Sales Position Customer Service Telemarketing Business Development Manager Branch Manager Masseuse Physiotherapist Homeopathy Nutritionalist Product Demonstator Naturopath Product Courier

What level of computer skills do you have?: Basic Intermediate Advanced None

Please describe in full your computer skills:


Are you currently employed?: YES NO If the answer is yes, on what basis?: Permanent Part Time Casual

If you are seeking a Casual Position, how many hours can you work?: 2 - 4 4 - 8 8 - 16 16 - 32 32 +

Details of current and previous employment (last 3 positions only):

Employer: Position held: From: To:

Reason for leaving:


Employer: Position held: From: To:

Reason for leaving:


Employer: Position held: From: To:

Reason for leaving:


Are you involved in any outside activity that would coincide with this position?:


Have you previously received or are you currently under review for Workers
Compensation payments for any injury or illness due to your employment?: YES NO

If you answered YES please provide full details below:


I agree to observe the company's safety, security and administrative rules and
regulations and pledge to conduct myself in accordance of company policy: YES NO

I understand that any information found to be false could lead to dismissal: YES NO

I certify that all the information I have provided in my application is correct: YES NO

Date of application: day 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st - month January February March April May June July August September October November December - year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018