MIKE BALL DIVE EXPEDITIONS PTY LTD

APPLICATION FOR EMPLOYMENT

INSTRUCTIONS: Please complete the following
Please email a current copy of your dive certification or drivers licence to our Employment Department.

(PART A)
POSITION APPLIED FOR: Date:
COMPLETE NAME: Date of Birth:
ADDRESS:              Email:
PHONE NO: Home: Work:
AUSTRALIAN DRIVERS LICENSE: Yes No  
TYPE: Yes No Typing speed:
SMOKER?  YES NO  
AUSTRALIAN CITIZEN?  YES NO If NO, attach copy of residency/Work Permit by email)
ARE YOU A SCUBA DIVER?
YES NO  DIVE CERTIFICATION LEVEL?

EDUCATION:
HIGH SCHOOL FROM: TO: LEVEL:
COLLEGE/UNI FROM: TO: LEVEL :
OTHER: FROM: TO: LEVEL:           

Please list any specialist training relevant to this position:


RELATED EXPERIENCE:


Do you have any physical or medical limitation which may affect your work?
  YES NO  If yes provide details below:


HOBBIES, INTERESTS, SPORTS:.


Work Related Skills in BUSINESS, DIVING, INSTRUCTING, MARINE, etc.


HOW OR FROM WHO DID YOU LEARN ABOUT THIS POSITION:

Expected Pay Scale: When Can You Start?: 


(PART B)
WORK EXPERIENCE
 (Start with your present or last position);

1. Company Name Phone:
Company Address
Kind of Business:   Your position:
Supervisor's Name: Employed from to

Describe your duties:


Pay: $. per Reason for leaving.

2. Company Name Phone:
Company Address
Kind of Business:   Your position:
Supervisor's Name: Employed from to

Describe your duties:


Pay: $. per Reason for leaving.

3. Company Name Phone:
Company Address
Kind of Business:   Your position:
Supervisor's Name: Employed from to

Describe your duties:


Pay: $. per Reason for leaving.

4. Company Name Phone:
Company Address
Kind of Business:   Your position:
Supervisor's Name: Employed from to

Describe your duties:


Pay: $. per Reason for leaving.

I hereby give my permission for Mike Ball Dive Expeditions to contact either the above Companies or the Referees provided in my Resume to obtain a reference Yes No
   
Mike Ball Dive Expeditions may keep my Application, Resume and relevant paperwork on file for six months from the date of this submitting this employment application submission: Yes No


(PART C)
MEDICAL HISTORY
Please answer the following questions on your past or present medical history with a YES or NO.
If you are not sure, answer YES.

Do you regularly take prescription or non-prescription medication?
(with the exception of birth control?) 		Yes No

Have you ever had or do you currently have:		  
History of diving accidents or decompression sickness? Yes No
Asthma? Yes No
A high cholesterol level?  Yes No
Frequent or severe attacks of hayfever or allergy? Yes No
Frequent colds, sinusitis or bronchitis? Yes No
Any form of lung disease?   Yes No
Pneumothorax (collapsed lung)?   Yes No
History of chest surgery? Yes No
Epilepsy, seizures, convulsions or take medications to prevent them? Yes No
Recurring migraine headaches or take medications to prevent them?   Yes No

History of blackouts or fainting (full/partial loss of consciousness)?

Yes No
Do you frequently suffer form motion sickness (seasick, carsick, etc)? Yes No
History of recurrent back problems?   Yes No
History of diabetes? Yes No
History of back, arm or leg problems following surgery, injury or fracture? Yes No
Inability to perform moderate exercise (eg: walk one mile within 12 minutes) Yes No
History of high blood pressure or take medicine to control blood pressure? Yes No
History of any heart disease?   Yes No
History of ear disease, hearing loss or problems with balance? Yes No
History of bleeding or other blood disorders? Yes No
History of any type of hernia? Yes No
History of ulcers or ulcer surgery? Yes No
History of drug or alcohol abuse? Yes No
History of skin disorders, dermatitis, melanomas, skin cancer, etc?. Yes No

Name: Date:

(PART D )
DIVEMASTER AND INSTRUCTOR APPLICATIONS
Please supply a copy of:

  • AS2299 Occupational diving medical (with audiogram)
  • First Aid and Oxygen Therapy certifications

Note: If successful in your application the above certifications must be valid for more than a 90 day period.

SKIPPERS, ENGINEERS AND DECKHANDS
Please supply a copy of:

  • Masters qualifications
  • Engineering qualifications
  • Coxswain qualification
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