Applicant Name:

Address Details:

Suburb Details:

Post Code:

State:

Mobile Phone:

Landline:

Email:

Make of Vehicle:

Model:

Year:

Registration No:

Tare Weight:

Tray / Van Length:

Pallet Spaces:

Colour of Vehicle:

Serviced Regularly: Yes No

Insurer Details:

Type of Policy:

Policy Expiry Date:

Dangerous Good Insurance: Yes No

If Yes - Insurer Name:

Policy Expiry Date:

Name on Licence:

Licence Number:

Expiry Date:

State of Issue:

Years Experience:

Remaining Demerit Points:

Have you ever lost your licence?:

Do you hold a current dangerous goods licence?: Yes No

Date of dangerous goods licence issued?:

Are you a member of the TWU?: Yes No

If yes - what is your badge no?:

Have you had an accident in the last 5 years?:

If yes - brief details:

Have you ever had experience in the transport industry?: Yes No

Current Employer:

Number of Years:

Average Weekly Earnings:

Current Hourly Pay:

Brief Explanation of Duties: