Employment Form Position Applied for* Picker Packer Pruner Tractor Irrigation Admin Type of work are you available for Full Time Part Time Casual Have you worked for Benning's before?* Yes No If yes do you know what your employee number is? Select* Mr Ms Miss Mrs Given Name Family Name Prefered Name Residential Address Mailing Address E-mail Home Phone Mobile Number Emergency Contact Person Emergency Contact Number Main Language Spoken Date of Birth Passport number Country of issue Superannuation Company Superannuation Member Number TAX File Number Bank Details BSB Account Number Please provide details of any work experience you have in the role you have applied for* Do you suffer any cardiac conditions?* Yes No Have you ever suffered from tuberculosis?* Yes No Do you suffer from hepatitis?* Yes No Do you suffer from HIV?* Yes No Do you have a pre-existing knee injury?* Yes No Do you have a pre-existing back injury?* Yes No Do you suffer from asthma?* Yes No Do you suffer from allergies to pollen, dust, chemicals etc.?* Yes No Are you allergic to bees?* Yes No Are you colour blind?* Yes No Do you suffer from epilepsy?* Yes No Do you suffer from dizziness?* Yes No Do you have diabetes?* Yes No If you answered yes to any of the above please explain the circumstances* I declare that to the best of my knowledge, the information given is true and correct. I understand that inaccurate, misleading or untrue statements or knowingly withheld information may result in termination of employment with this organisation. I understand and agree that, my right to work in Australia will be verified. I understand that this application does not constitute an offer of employment. I acknowledge that I have received induction details and Fairwork information. I acknowledge that checking this box it is my binding digital signature and agree to the above declaration* Yes Date Add Files to your application (max. 5mb) jpg, jpeg, gif, png, docx, xlsx, pdf Upload Add Files to your application (max. 5mb) jpg, jpeg, gif, png, docx, xlsx, pdf Upload Submit