Apprentice job application

Confidential Pre-Employment Medical Check

We need to ensure that you are medically fit to perform the role you are applying for and that, if required, we can provide reasonable support if you need it. Please ensure you have read and understood the Position Description

If your application proceeds, it will be subject to passing a medical examination which includes a review of your answers below, colour blindness, drug screening and hearing testing. To help us perform these assessments and to keep you safe, we are relying on you to answer these questions honestly. False or misleading responses can result in disciplinary action which may in future result in the termination of your employment and may impact your entitlement to any applicable workers compensation.

Full Name (certifying the below statement)

I (named above) certify that the particulars contained in the Pre-Employment Medical Check are true and correct to the best of my knowledge and authorise MPA to discuss the details with appropriately qualified medical personnel and the host employer for the purpose of assessing suitability for the role and supporting my employment.

I understand that in all other respects MPA is bound by the Privacy Act 1988 and will not disclose the information contained in this Pre-Employment Medical Check without my permission, but that MPA may be required to disclose this information by instrument of the law.

Health Screening

Do you smoke cigarettes?*

Yes
No

No cigarettes per day?*

Do you drink Alcohol?*

Yes
No

No standard drinks per day*

Do you take prescription medication?*

Yes
No

prescription medication type and dosage*

Do you take non-prescription medication or drugs?*

Yes
No

non-prescription medication type and dosage*

Do you have vision impairment or colour blindness?*

Yes
No

Do you have any hearing problem or condition?*

Yes
No

Do you have any balance problems?*

Yes
No

Are you affected by heights or confined spaces?*

Yes
No

Do you suffer from any skin condition?*

Yes
No

Do you have any repetitive strain, musculoskeletal injury, arthritic condition or weakness?*

Yes
No

Do you suffer from a heart or blood clotting condition?*

Yes
No

Do you suffer from a sleeping disorder such as sleep apnea or do you experience fatigue?*

Yes
No

Do you suffer from high or low blood pressure?*

Yes
No

Do you suffer from Asthma or any respiratory or lung condition?*

Yes
No

Do you suffer from Epilepsy or any other condition affecting the nervous system?*

Yes
No

Do you suffer from a diabetic condition?*

Yes
No

Have you ever suffered from any form of cancerous skin condition?*

Yes
No

Are you currently vaccinated for hepatitis A & B?*

Yes
No

Do you suffer from any allergies that you may be exposed to while a plumbing apprentice?*

Yes
No

If you have answered ‘yes’ to any of the above, please tell us more information as to the nature of the condition

Do you have any difficulties with the following activities?

Walking on rough ground*

Yes
No

Climbing a ladder or steps*

Yes
No

Kneeling or crouching*

Yes
No

Using hand tools*

Yes
No

Stranding for more than 2 hours*

Yes
No

Sitting for more than 2 hours*

Yes
No

Turning your head rapidly*

Yes
No

Concentrating on what you are doing*

Yes
No

Having a conversation in English*

Yes
No

Gripping firmly with both hands*

Yes
No

Lifting or bending*

Yes
No

Using hand tools*

Yes
No

Reading ordinary print*

Yes
No

Repetitive movement of hands or arms*

Yes
No

If you have answered ‘yes’ to any of the above, please tell us more information as to the nature of the difficulty

Please provide details of any surgical procedure, serious condition or injury requiring attendance at a hospital in the last 10 years:

Your Contact Details

Eligibility for Registration as a Funded Australian Apprentice

Employment Status

Funding Categories

Transportation & Getting to Work

Schooling

Working with Children Check

Attachments to Application

Victorian Building Authority Requirements

Confidential Pre-Employment Medical Check

Health Screening

Declaration

Apprentice job application

Your Contact Details

Eligibility for Registration as a Funded Australian Apprentice

Employment Status

Funding Categories

Transportation & Getting to Work

Schooling

Working with Children Check

Attachments to Application

Victorian Building Authority Requirements

Confidential Pre-Employment Medical Check

Health Screening

Declaration

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Sorry, we're only servicing the state of Victoria right now.
Please enter a 4-digit Victorian postcode

Just letting you know

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