Fillable Printable Queens Supermarkets (WA) Pty Ltd Employment Application Form
Fillable Printable Queens Supermarkets (WA) Pty Ltd Employment Application Form
Queens Supermarkets (WA) Pty Ltd Employment Application Form
Queens Supermarkets (WA) Pty Ltd
Trading as
Rigters Supa IGA, Queens Supa IGA & Wonthella Supa IGA
Page 1
Employment Application
PERSONAL DETAILS:
Mr Ms Miss Surname: First Name:
Residential address:
Suburb: State: Postcode:
Phone numbers: (H): (M):
E-mail address:
Are you legally entitled to work in Australia? Yes No
If no, what type of visa do you hold?
Do you hold an Australian Drivers Licence? Yes No
EDUCATION DETAILS:
School/Institution attended From To Level achieved
Are you currently studying? Yes No If yes, please specify:
What is your mode of study? Full time Part time External
EMPLOYMENT PREFERENCES:
Preferred Location: Rigters Supa IGA Queens Supa IGA Wonthella Supa IGA
Preferred Status: Full time Part-time Casual
Please tick your preferred position(s):
Management Tradesperson Warehouse
Store Manager Qualified Butcher Warehouse Supervisor
Department Manager Qualified Baker Warehouse Store Person
Service Assistant
Qualified Pastry Cook Nightfill
Checkout
Produce
Apprenticeship Other
Meat Butcher Merchandising
Deli Baker Support Office
Bakery Stock Taker
Grocery
Traineeship Other (please specify)
Seafood Retail Traineeship
Queens Supermarkets (WA) Pty Ltd
Trading as
Rigters Supa IGA, Queens Supa IGA & Wonthella Supa IGA
Page 2
AVAILABILITY:
Please specify the days you are available by placing a tick in the appropriate boxes below.
(Please note, you would be not required to work the specified times, only during that time frame.)
Please provide details of any hobbies, sports or other recreational activities that may affect your
availability for work:
If required, are you prepared to work overtime? Yes No
When are you available to start work?
EMPLOYMENT HISTORY:
Please specify your employment history (most recent first)
Employer Date from Date to Position Reason for leaving
Have you previously been employed by Queens Supermarkets (WA) Pty Ltd or Supa IGA? Yes
No
If yes, please provide details:
Store Name:
Position Held: Reporting to:
Period of Employment - From: Date:
Reason for Leaving:
Do you have any objection to inquiries of your present employer regarding qualifications and
character? Yes No
GENERAL INFORMATION:
Have you ever had a criminal offence proved against you? Yes No
If yes, please provide details:
Have you ever been dismissed/terminated for dishonesty, or been the subject of an investigation that
resulted in your resignation? Yes No
If yes, please provide details:
_
If you are successful in gaining employment, do you agree to complete a pre-start online induction, as
part of your training, before commencing your employment? Yes No
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
(6am-12pm)
Afternoon
(12pm-6pm)
Evening
(6pm-6am)
Queens Supermarkets (WA) Pty Ltd
Trading as
Rigters Supa IGA, Queens Supa IGA & Wonthella Supa IGA
Page 3
PHYSICAL CAPACITY:
Do you suffer from any serious illness, disease or disorder? Yes No
If yes, please provide details:
Do you have any physical condition or disability which may preclude your ability to perform or limit
the particular position for which you are applying? Yes No
If yes, please provide details:
Have you ever had any work related injuries? Yes No
Have you ever made a Workers Compensation claim? Yes No
If yes, please provide details below:
Date of injury:
Type of injury:
Employer at time of injury:
Job position at time of injury:
Amount of time off work:
Final Medical clearance received:
Current limitations:
REFERENCES:
Please provide three work related references
(preferably direct supervisor).
Students may use teachers or tutors.
1.
Name
Title
Company
Phone Number
2.
Name
Title
Company
Phone Number
3.
Name
Title
Company
Phone Number
RELATIONSHIP TO OTHER EMPLOYEES:
Please list the names of any relatives who currently work within Queens Supermarkets (WA) Pty Ltd
or Supa IGA.
Name Position Store Name Relationship
Please list any other current employees you know:
Queens Supermarkets (WA) Pty Ltd
Trading as
Rigters Supa IGA, Queens Supa IGA & Wonthella Supa IGA
Page 4
DECLARATION
Your signature below indicates your consent to the use and disclosure of your personal information as indicated above.
In applying for employment with Queens Supermarkets (WA) Pty Ltd hereafter referred to as “the Company”, you agree to
the following:
I can provide evidence that I am qualified to work in Australia (e.g. birth certificate, evidence of citizenship,
working visa).
I confirm that the information given on this form is true and complete and understand that the provision of wrong
or misleading information may result in disciplinary action up to and including termination of employment.
I consent to the Company contacting my referees and using, disclosing and storing the information obtained from
my referees to assess my suitability for my employment with the Company.
If required, I agree to undergo a pre-placement and subsequent health assessment with a medical provider
nominated by the Company to assess my physical capacity to carry my duties.
I agree that any monies owing to the company shall be deducted from my pay at the discretion of the Company.
I agree to abide by all employment conditions, company policies, procedures and safety requirements.
I understand that failure to disclose details of a previous medical condition or Workers’ Compensation claim may
disqualify me from receiving compensation under the Workers’ Compensation and Rehabilitation Act of 1981 (as
amended) in respect to any aggravation, exacerbation, deterioration of such a medical condition.
I agree that the Company reserves the right to have me perform duties or roles other than those I was originally
hired to do and may transfer me to a different operation, function or location. Should I be transferred I agree to
work in any location operated by the Company under the terms and conditions of that site.
Applicant Signature: Date:
Parent/Guardian Signature: Date:
(if under 18)
CONTACT US
Please forward completed application to your preferred store via any of the details below. Please note, if you would like to
apply at multiple stores you will need to send multiple applications.
Rigters Supa IGA:
In Person: 179 Durlacher Street Geraldton WA 6530
Post: PO Box 1695 Geraldton WA 6531
Fax: 08) 9921 3682
Email: rigterssupaiga@rigtersupermarkets.com.au
Queens Supa IGA:
In Person: 79 Durlacher Street Geraldton WA 6530
Post: PO Box 1695 Geraldton WA 6531
Fax: 08) 9964 5318
Email: queenssupaiga@rigtersupermarkets.com.au
Wonthella Supa IGA:
In Person: 252 Fifth Street Wonthella WA 6530
Post: PO Box 1695 Geraldton WA 6531
Fax: 08) 9964 3111
Email: wonthellasupaiga@rigtersupermarkets.com.au
