Your Name:

Age:

Todays Date:

Sex:

FemaleMale

D.O.Birth:

Address:

Postcode:

Mobile:

Home Phone:

Email:

Phone 2:

Next of Kin:

Kins' Number:

Production Experience

AudioBacklineCorporateDrapesEWPFork LicenceGreen CardLightingMR LincenceOperatorPaintingSpotlightVideoSteelNo Experience

List your other qualifications & licences:

Please list bands you worked with:

Please list films/theatre shows you have worked with:

Do you have a vehicle?

YesNo

Licence Number

Vehicle Type

Physical Details

Height (cm):

Weight (kg):

Waist (cm):

Shirt Size:

SMLXLXXL

Strength:

ModerateAverageStrongV Strong

Fitness Level:

PoorAvreageFitVery Fit

Medical History

Please list allergies, illness, phobias, back or arm conditions that we should note when aloocating you work:

Have you made a Wokers Compensation Claim before?

YESNO

If yes: What was injury sustained?

Who was your employer at the time?

Who was your employers insurer?

What was the outcome of your rehab?

SELF INSURANCE DETAILS

Pls. Note: Certificate of Insurance(s) are required if Self Insured

Do you have your own Public Liability ($20,000,000.00)?

YesNo

If yes please note Public Liability Insurer & Policy Number

Do you have your own Income Insurance?

YesNo

If yes please note Income Insurer & Policy Number

Bank Details - for Invoice Remittance System

Name on Account

BSB # :

Account # :

Name of Bank or Building Society:

Type of Acc:

I certify that, the above information about me is true and correct.

TFN: