Employment Agents Licence 1335

R.A.N.Z.A. - Australia wide Fax Australia 08 9797 0806 Phone Aus. 08 9797 0249 Rural Employment Agency Fax NZ 0061 8 9797 0806 Phone NZ 0061 8 9797 0249 Employment Agents Licence 1335 www.ranzaruralemployment.com.au email: [email protected]

REGISTRATION FORM ( 1 of 2 forms ): Form to be completed in full regardless of other information attached, do not fax certificates or more than a 3 page resume. Please send two recent written references . Permanent positions require a c.v. Without 2 ph referees we cannot process your application.(please use black pen)

Name:______Country______Postal Address______State/Province______Tele: ______Fax______Mobile______email: ______date available from ____/___/___to____/___/___ Age: _____Married/Partner Yes/ No. Single Yes/No. Children _____Ages ______SmokerYes/No Social Smoker Only Yes/No. Nationality______Passport Yes/No. Issued______(country) Disabilities Yes/No - Type______Criminal ConvictionYes/No Type______Has RANZA placed you before Yes/No Clients name______Date______Drivers License Type: C. LR. MR. HR. HC. MC NZ 1. 2. 3. 4. 5. Other______Name of next of Kin __ Phone Contact______

Circle preferences below: (Required for selection purposes) Position : Seasonal - Permanent Location: W.A. VIC. N.S.W. S.A. TAS. Qld, N.T. - Australia wide. Cropping: Manager,Overseer,Couple,Farmhand,Tractor,Airseeder, Boomspray,Truck/Fert. Spreading,Header,Chaser Bin,Truck,Baler,Loader,Mechanic,Cook,Housekeeper. Dairying: Sharefarmer/milker, Manager,Assist.Manager,Herd Manager,Assist.Herd Manager Couple: Partner full time, part time, relief, not working.Dairy Hand: Snr. Jnr. Livestock:Manager,Assistant Manager,Overseer,Couple,Stationhand: Snr. Jnr.Fencing, Pilot ,Mechanic,Engineer,Caretaker,Cook,Housekeeper,Nanny,Trainee. Positions held please: list the last four positions held farming or other. Employer Date Employed from Employed to Title of Employees Position 1 2 3 4 Phone referees: - relating to your farming/other experience (last 5 years) – Phone referees for their agreement. Referees Name Referees Occupation Yr Employed Referees Phone 1 2 3 4 DECLARATION:PLEASE READ AND SIGN _Your signature forms the contract between yourself the registered employee and R.A.N.Z.A. Australia wide. I certify the above details are true and correct I have no known illness, medical condition or disability that would affect my employment, my drivers licences are current I have no pending driving or other offences. I agree for R.A.N.Z.A.to forward my profile to prospective Employers and for R.A.N.Z.A/prospective Employers to contact my phone referees .On accepting a position I undertake to immediately advise R.A.N.Z.A with the date of arrival to the position, also if a permanent position is offered and accepted after seasonal work. I undertake to advise RANZA of any offer of repeat employment from an Employer. For 3 years I agree & undertake not to offer/organise/refer additional Staff to Clients we have referred you to or request our Clients to find you a position with other Employers, our Clients cannot legally refer you or your friends/contacts etc. under referral laws and their Contract with us.

Signature ______Date______Phone______

Mobile______Please print phone numbers clearly. R.A.N.Z.A. - Australia wide Fax Australia 08 9797 0806 Phone Aus. 08 9797 0249 Rural Employment Agency Fax NZ 0061 8 9797 0806 Phone NZ 0061 8 9797 0249 Employment Agents Licence 1335 www.ranzaruralemployment.com.au email: [email protected]