Confidential Application for Employment

Please read the following Privacy Statement before filling out your application.

Alive Clinics Pty Ltd Privacy Statement

Alive Clinics Pty Ltd and its subsidiary companies is fully committed to meeting the requirements of the Privacy Act 1988 (Cth) and the Health Records Act 2001. The personal information collected on this application form will be used to assess the suitability of the applicant for the position advertised and to negotiate with and make offers of employment to selected applicants. Further, for successful applicants, the information will be used for the supervision, management and payments of employees, to develop and maintain the employment relationship between the employer and the individual.

Fields marked with (*) on the application form are regarded as mandatory for selection purposes. Failure to provide these data may influence the processing and outcome of your application. However, for successful applicants, the information supplied in the application form may be passed onto our insurers, bankers, any relevant staff union and superannuation fund managers.
It is the policy Alive Clinics Pty Ltd to retain the personal information of unsuccessful applicants for future recruitment purposes for a period of 6 months.

Under the Privacy Act 1988 (Cth), applicants have the right to request access to, and to request correction of their personal information collected in this form. If you wish to exercise these rights, please contact the Privacy Officer in your State.

Alive Clinics Pty Ltd and its subsidiary companies will not disclose such health information of applicants to a third party without first obtaining the applicant’s consent unless the disclosure is required by law or by statutory authorities.

Personal Details

Position: Receptionist Position
Therapist Position
If other, please specify:
Employment Type:

Preferred Location:
*Full Name:
*Home Phone:
*Work Phone:
*Date of Birth:
Birth Certificate Sighted:
Drivers Licence Number:

Next of Kin in Case of Emergency


Health History

*Do you have currently or have you had any health problems which may interfere with the performance of the position applied for?
If yes, please specify:
If yes, please specify:
If yes, please specify:
If yes, please specify:
If yes, please specify:
*Do you, or have you ever suffered from:
Date of last occurrence:
Skin Disorders/Allergies:
Date of last occurrence:
Back Disorders:
Date of last occurrence:
Date of last occurrence:
Joint or Muscular Injuries:
Date of last occurrence:
*Other serious illness, state details:
*Will any of the problems stated affect your work performance?
*Have you ever lodged a claim form for workers compensation?
*If so, please state details:
*Are you at present in good health?


Employees Name:
Date available to start:
*Means of Transport:
*Days and Times Available:
Shirt Size:

Personal History

*Have you ever worked for the company before?
If yes, state details and reasons for leaving:
A criminal record will not necessarily preclude you from employment, but full disclosure is required.
*Have you ever been convicted of a criminal offence?
*If yes, give details:
Have you any relatives in our employ?
If yes, state details:
Are you currently employed, attending training, university or college?


Level or Course Title Name of School College or University Location Year Pass/Fail Standard Reached

Previous Employment History

Company Name Phone No. or Address Date From Date To Reason for Leaving
*Work Reference Contacts:  
Name 1:
Company 1:
Phone 1:
Name 2:
Company 2:
Phone 2:
Name 3:
Company 3:
Phone 3:
Normal Trade :
Reason for applying for the job:
Why do you think you should be considered?
Do you like shift work?
How much do you wish to earn per week?
Experience: Medical Reception Experience
Beauty Therapy Experience
Management Experience
Computer Skills: Word
Medical Director
If other, please specify:
Any hobbies?


I have checked that all questions have been answered in full and when submitting this application I understand the following :

  1. This contract shall be void if I do not report for duty, at the due time and date of starting.
  2. I shall abide by the rules of the company.
  3. I am able to notify the company of any change of address.
In submitting this application for employment I understand that misrepresentation of facts is sufficient cause for dismissal.



 I have read and accept the above terms