Form – General Labour Questionnaire

Please type your full name *

Phone *

1. As you are applying for an Industrial Labour position, are you able to meet the physical demands? *

If no, what are your limitations

2. Do you have difficulty bending, crouching, lifting, twisting, or reaching? *

If yes, what are your limitations

4. Are you available to work overtime if required? *

5. How do you get to and from work? *

6. Are you available to work in a dusty environment or a place with odours etc.? *

7. Are you involved with any activities that would prevent you from reporting to work on time? *

If yes, what are your limitations

8. Have you injured yourself in the past where it interfered with your ability to perform tasks? *

If yes, what are your limitations

9. Have you ever been charged with a criminal conviction for which you do not have a pardon? *

If yes, please explain

11. Why did you leave your last job? Please explain.

12. Is there anything else we should be aware of when offering you a placement or assignment?