Liveaboard Scuba Diving on the Great Barrier Reef and Coral Sea

(Part A)
POSITION APPLIED FOR: *
Date: *
COMPLETE NAME: *
Date of Birth: *
ADDRESS: *
Email: *
Phone No. Home:
Phone No. 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?:
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:
Employed 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:
Employed 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:
Employed 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:
Employed 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? :	Yes No (with the exception of birth control?)
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

Liveaboard Scuba Diving on the Great Barrier Reef and Coral Sea

Online application form

(Part A)

(Part B)

(Part C)

(PART D )