DECLARATION FORM

We specialise in agricultural recruitment and farmers look for those with relevant experience and trades.

Please complete the following information. Fields marked (*) are mandatory:

Name

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Email Address

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What is your Salary/Hourly Rate Expectations?

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Emergency Contact - Name:

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Emergency Contact - Phone Number:

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Weight:

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Height:

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REFERENCES (if not listed in your resume): Please ensure you provide two contactable employment references from recent and relevant (ideally direct) Supervisors. Ensure the numbers are correct, including country codes.

1: Referee Name:

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Company Name / address:

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Position Title:

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Did you report to this person?

Yes No Invalid Input

Contact Number:

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Email Address:

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Please list your second referee here (if not listed in your resume):

2: Referee Name:

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Company Name & address

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Their position title:

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Did you report directly to this person?

Yes No Invalid Input

Phone Number:

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Email:

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Physical/Health History

Do you have any disabilities that may interfere with your work?

Yes No Invalid Input

Are you required to take prescribed medication which may affect your work performance or attendance at work?

Yes No Invalid Input

Do you or have you ever had back, neck, shoulder, knee or joint problems that would preclude you from performing the duties required by the role?

Yes No Invalid Input

Is there any reason why you can not wear safety or protective equipment?

Yes No Invalid Input

If you have answered yes to any of these questions, please provide further details:

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Are you willing to undergo a pre-employment medical?

Yes No Invalid Input

Are you willing to take random alcohol and other drugs test?

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If you have any known allergies, please provide details here (eg, food, medications):

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Declarations

I permit Rural Enterprises to contact referees listed:

Yes No Invalid Input

I allow Rural Enterprises to retain any information for their records:

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Rural Enterprises may forward relevant information to prospective employers:

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I understand I must inform Rural Enterprises of my return to any employer they have introduced me to:

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I understand that I may be placed in an isolated work environment. As such, I will inform my prospective employer of any health related issues and prescribed medication that may be needed in case of an emergency. I also give Rural Enterprises permission to notify any prospective employers of this.

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NB: In order to proceed with your application we require a copy of your passport photo page or birth certificate, visa details and valid drivers licence. Please ensure you provide a copy, if you haven't already done so, as soon as possible.

By submitting this form, I declare that each and every answer is true to the best of my knowledge and belief. I understand that any false or misleading information may result in termination of employment.

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We specialise in agricultural recruitment and farmers look for those with relevant experience and trades.

By submitting this form, I declare that each and every answer is true to the best of my knowledge and belief. I understand that any false or misleading information may result in termination of employment.

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