Login: Password:

Section 1: Name and Contact details (Please print clearly)
Surname:		Given Names:
Suburb:		State:				Postcode:
Contact Details::
Home:		Mobile:				Fax:
Date of Birth:		Place of Birth:				Residency Stature:	Select Fiji Citizenship Permanent Resident Working Visa Other
Marital Status:	Select Married Single	No. of Dependants:
Emergency contact name:
Email Address:

Section 2: Credentials (copies of all relevant documents to be submitted)
Security Licence No.:		Licence Class:
Licence Conditions:		Licence Expiry:
First Aid Certificate:		First Aid Expiry:
Drivers Licence No.:		Vehicle Class:				State:
Licence Conditions:		Licence Expiry:

Section 3: Medical Conditions (Required to comply with our Occupational Health and Safety requirements)
Please list any physical deformity or medical condition:
Do You Suffer From Any of the following conditions?:
Asthma:	Select Yes No	Heart Disease / Disorder	Select Yes No	Epilepsy:	Select Yes No
Any Mental Condition:	Select Yes No	HIV Related Illness:	Select Yes No	Hearing Loss:	Select Yes No
Any Back Conditions:	Select Yes No	Limb / Joint Conditions:	Select Yes No
Do You Suffer from Allergies:	Select Yes No	if Yes state Here
Do YouHave any Previous Injuries:	Select Yes No	if Yes state Here
Please State your Religion:
Do you require Religious days off?	Select Yes No	if Yes state Here
Do you agree to attend a "Medical" by our Medical Practitioner, if or when necessary:			Select Yes No
Have you ever had a Workers Compensation Claim:			Select Yes No
if Yes Please give details:

Section 4: Legal Matters (Required in order to comply with our company standards and security industry)
Have you ever had an AVO taken against you		Select Yes No
If you answered yes please give details:
Have you ever been charged with an offence in NSW or elsewhere:		Select Yes No
If you answered yes please give details:
Are you to your knowledge, under investigation, charged or awaiting hearing:		Select Yes No
If you answered yes please give details:

Section 5: Protected Services Administration Details
Height (in centimetres):		Weight (in kilograms):
Banking Details:
Name of Bank:		Branch:
BSB Number		Account Number:			(Office Use only) Payroll No.
Your Tax file Number:

Section 6: Security Industry General Experience (Required for duty allocation and further training)
Have you ever had any experience in any of the following security duties:
Static Security:	Select Yes No	Retail Loss Prevention:	Select Yes No	Alarm Installation:	Select Yes No
Building Security:	Select Yes No	Crowd Control:	Select Yes No	CCTV Installation:	Select Yes No
Mobile Patrols:	Select Yes No	Bag Searches:	Select Yes No	Access Control Installs:	Select Yes No
Concierge Security:	Select Yes No	Body Searches:	Select Yes No	CCTV Operation:	Select Yes No
Airport Security:	Select Yes No	Backstage Security:	Select Yes No	Control Room Duty:	Select Yes No
Train Security:	Select Yes No	Barrier Security:	Select Yes No	Alarm Monitoring:	Select Yes No
Cash Escorts:	Select Yes No	Bar/Hotel Security:	Select Yes No	Security Consulting:	Select Yes No
VIP Escorts:	Select Yes No	Guard Supervision:	Select Yes No	Security Management:
Please list any other skills that you think will assist you with your work

Section 7: Employment History (Please list your last three employers, starting from the current employer)
Employer:		Address:
Position Held:		Duties:
Supervisor:		Phone No.:
Start Date:		End Date:
Employer:		Address:
Position Held:		Duties:
Supervisor:		Phone No.:
Start Date:		End Date:
Employer:		Address:
Position Held:		Duties:
Supervisor:		Phone No.:
Start Date:		End Date:
Do you consent to us contacting any of the above employers:			Select Yes No

Section 8: Declaration of Undertaking (Please sign the following statement)
I declare that the information given in this application is true and correct. I agree and give consent to Protected Services to make enquiries into my character and background in order to verify the information supplied by means of contacting, employers, colleges, referees and other associations or institutions. I understand that should the information I have supplied be found to be intentionally misleading or false, this could lead to immediate disciplinary action including dismissal from the company. I understand that employment with Protected Services is not “Site Specific” and that I may be required to work at any site where the company has been engaged to undertake security services.
	SIGNED:…………………………………………………… DATE:………………………	DIGITAL SIGNATURE:
	(Applicant Signature)