Contact

Personal Details

Gender:

How did you hear about us?: WebsiteNewspaper AdReferral By:

Emergency Contacts

Work Eligibility

Qualifications/Training and Licences

Trade:

Other Qualifications/Training:

Drivers Licence Code:

PDP (yes or No):

Employment History

Please note that any referees listed (or company listed HR departments) may be contacted as a part of our recruitment process.

Health And Fitness

It's important that you are medically fit to perform the duties associated with the position that you are applying for.

Do you agree to undergo a full pre-employment medical and/or drug screen?:

Are you currently taking any medications which may affect your ability to work in a safe capacity?:

If yes, please provide details:

Have you ever made a claim for workers compensation?:

If yes, please provide details (date, injury etc):

Do you have any current or past medical condition which may affect your ability to work in a safe capacity or which your supervisor needs to be made aware of?:

If yes, please provide details:

Criminal Record

It is a requirement by many of our clients and project sites that our personnel provide a Police Clearance Certificate or undergo a Criminal Record Verification process through an independent screening company.

Do you have a criminal record or any pending cases against you?

If you have answered yes, please provide details:

Declaration

I declare that the information I have provided on this form is true and correct. I understand that deliberate omission of information may subject me to instant dismissal. I authorise Relines South Africa to contact my references as listed above.

I Agree

* Required Fields

Phone:	+27 837 810 920
Fax:	08 6210 1464
Email:	relines@relinessa.com

Phone:	+1300 473 546
Email:	relines@relines.com

African Operations:

Johannesburg – South Africa
Roodepoort,

Australian Operations:

Perth – Western Australia

Our Clients