AMJV Registration Documents Rv18

AMJV APPLICATION CHECKLIST
Please note that we are unable to process incomplete applications. This checklist has been created to assist you with
filling in your documents. Once you have completed your paperwork please ensure that you run through this checklist
before you return your application.
Resume
Up to date resume must be sent through
Registration of Interest Form

ALL 20 Pages of the ROI must be returned including any pages that are not relevant to you
Page 2 – Signatures and date
Page 4 – tick one position only
Page 5 – state years and months experience in the chosen position
Page 18 – may we contact your current employer for a reference Yes/No?
Page 18-19 – Employment history must cover the whole of the past 5 years without any gaps
Any gaps of employment must be stated i.e. – unemployed, home duties, travelling, studying.
Full names of referees must be provided along with contact numbers
Usual Place of Residence

Print name, full address stated, signed and dated
Planned Leave Declaration Form

Must complete sign, date and return the form even if you have no planned leave
Proof of Entitlement Form

Full name, sign and date
PPE Form
Shirt & pants (cm) or overalls, boots size, prescription glasses required
Sign and date at the bottom
Training Registration Form

Ensure you provide your unique USI number on the form. You can obtain this online (see form)
Tickets and Licences

All relevant tickets, licences and qualifications
Full colour, front and back
Passport or Australian Birth Certificate

Colour copy required where applicable
Journey Plan
Please complete and ensure you list your Point of hire (POH) and print sign and date at bottom of page 2.
NOTE: - No electronic signatures will be accepted on the paperwork
Please contact the AGC recruitment department via phone or email if you have any queries or need assistance with filling in your
paperwork.
REGISTRATION FORM
ICHTHYS PROJECT ONSHORE LNG FACILITIES
WORKER
PLEASE READ AND ENSURE YOU UNDERSTAND THE FOLLOWING BEFORE COMPLETING THIS FORM.
1. Complete all sections. Incomplete forms cannot be processed.

2. Attach photocopies of supporting documentation such as licences and certificates to this form. Do not attach originals. If you do not
have copies with you when completing this form, your registration cannot be processed until you provide your copies.
3. Submitting this form is not an offer of employment and does not guarantee employment on the Ichthys Project onshore LNG facilities
(the Project).
4. We may contact any of your previous employers shown on this form for the purpose of confirming your employment details and
determining your suitability for employment.
5. If you are being considered for work on the Project, the information supplied on this form and our confirmation of your work history
shall be provided to the Project via their authorised service provider Bright People Technologies Pty Ltd and this information will be held
on a database. (See further details in the Declaration).
6. If you are offered and accept work on the Project, information will be provided to the Project and Bright People Technologies Pty Ltd
about your mobilisation, work and demobilisation on the project and may be used in relation to other projects that may arise in the
future. (See further details in the Declaration).
DECLARATION
BEFORE SIGNING THE DECLARATION BELOW, PLEASE READ THE FOLLOWING POINTS AND CLARIFY ANYTHING THAT YOU ARE UNSURE OF WITH THIS COMPANY'S
RECRUITMENT STAFF
1. If I am considered suitable for an interview I understand that the information I have provided, and subsequent confirmation of my work
history by this Company, shall be provided to the Project via authorised service provider Bright People Technologies Pty Ltd, for the
purpose of confirming my suitability for employment opportunities on the Project.
2. If I am offered and accept employment on the Project, information will be provided to the Project, via Enable about my mobilisation,
including that I have satisfactorily met pre-employment checks, such as a Fitness for Work Medical; and information gathered during
the project, such as induction and training records and my demobilisation details.
3. I understand that if I am offered and accept employment on the Ichthys Project onshore LNG facilities, the Project and Bright People
Technologies Pty Ltd may provide the information to authorised service providers, engaged to manage matters relating to employment
on the Project.
4. I understand that the information may also be used and disclosed by Bright People Technologies Pty Ltd for the purpose of confirming
my suitability for employment opportunities in connection with other projects that may arise in the future, and for managing matters in
connection with my employment on other future projects.
5. Should I be engaged with a contractor organisation on the Project and subsequently be engaged with a new or additional contractor
organisation, I authorise the information held about me by the Project and Enable to be made available to that new or additional
contractor organisation.
6. I understand that the information will be held on a database and if I wish to, I can contact Bright People Technologies Pty Ltd at PO BOX
1010, West Perth WA 6872 to request this information. I can also request to correct or update the information.
7. I certify that the information set out in this form to the best of my knowledge, is true and accurate.
8. I understand the Company reserves the right to verify all information and any false statements will be sufficient to cause my rejection
as an applicant, my dismissal if hired, or termination of my agreement or contract.
9. Bright People Technologies Pty Ltd will only collect, use, disclose and manage your personal information in a manner which is consistent
with its obligations under Australian privacy law.
FITNESS FOR WORK
It is important that you be medically fit to perform the duties associated with the occupation or position(s) you are registering for:
Do you agree to undergo a full pre-employment medical and physical assessment (including a drug and alcohol screen) at X Yes X No
the Company's expense?
Part of the Project’s Fitness for Work policy includes a random Drug and Alcohol Program to help ensure employees are X Yes X No
not impaired whilst at work. Do you agree to participate in this Program?
Depending on the requirements of the work, some activities may be carried out at heights. Is there any medical condition X Yes X No
or other reason to prevent you working at heights?
Do you agree to not be in possession of or under the influence of, intoxicating liquor or drugs on the Project? X Yes X No
Is there any reason preventing you from wearing or using Personal Protective Equipment (PPE)? X Yes X No
If you answered "YES" to the above; please provide details.
OTHER PROJECT REQUIREMENTS
The Project involves construction activity and operational areas. It is therefore very important to observe certain rules and requirements. Are
you prepared to:
Comply with all Company and Project safety rules and procedures? X Yes X No
Wear and use the Project security swipe and identification card to enter and leave the site? X Yes X No
Wear and use the appropriate safety harness when working at heights? X Yes X No
Comply with all security requirements including vehicle, baggage and personal searches? X Yes X No
If you are a smoker, are you prepared to comply with all Project rules, which restrict smoking? X Yes X No
Wear and use the correct personal protective equipment? X Yes X No
© Copyright Bright People Technologies Pty Ltd. Page 1 of 20 May not be reproduced without permission.
Not carry or use any mobile phones at the workplace unless authorised by the Project? X Yes X No
Not carry or use any form of camera (including mobile phone cameras) on the Project? X Yes X No
Not use, carry, or be in possession of any weapons or firearms on the Project? X Yes X No
Not use, carry or be in possession of any matches, lighters or other spark emitting devices on the Project? X Yes X No
Agree to work shift work if required, subject to being medically fit to do so? X Yes X No
Agree to motel in project camp accommodation and follow all camp rules? X Yes X No
DECLARATION OF USUAL PLACE OF RESIDENCE
If you are engaged on the Project, the following declaration will determine your employment entitlement as either a "Local Employee" or a
"Non-Local Employee".
I, declare that my usual place of residence is:

(print name)
Post Code
(address)
Telephone Number ( )
I understand that this declaration determines, for the duration of my employment, my entitlements to either that of a "Local Employee" or that
of a "Non-Local Employee".
Signed
(signature)
SIGNATURE
I, have read, understood and agree to the terms outlined in

(print name)
this document.
........./........../..........
(signature) (dd/mm/yyyy)
RETURN THIS FORM TO
AMJV (AGC Industries & Meisei Industrial Joint Venture)

Level 1, 18-32 Parliament Place
West Perth WA 6005
AUSTRALIA
PERSONAL INFORMATION
Title: X Mr X Ms X Mrs X Miss X Dr X Prof

Surname: First Name(s):
Middle Name(s): Preferred Name:
Date of Birth: (dd/mm/yyyy) Email:
USUAL PLACE OF RESIDENCE

Residential address required - Post Office, 'care of' or employer addresses are unacceptable
Street: Suburb:
State: Post Code:
Country:
TELEPHONE
Home Phone: Work Phone:
Mobile Phone:
WORK ENTITLEMENT
Are you legally entitled to work in Australia without a visa? X Yes X No
INDIGENOUS
Are you of Aboriginal or Torres Strait Islander descent (optional)? X Yes X No
EMERGENCY CONTACT INFORMATION
This person must be a next of kin who can actually be contacted in the event of an emergency. The address must be their actual home
address. A post box is not acceptable. At least one of these contacts must be in Australia.
Relationship:

Street: Suburb:
State: Post Code:
Country:
TELEPHONE
Mobile Phone:
EMERGENCY CONTACT INFORMATION (OPTIONAL)
This person must be a next of kin who can actually be contacted in the event of an emergency. The address must be their actual home
address.
Relationship:

Street: Suburb:
State: Post Code:
Country:
TELEPHONE
Mobile Phone:
CONSTRUCTION/PROJECT EXPERIENCE
Are you currently employed by the company that you are completing this form for? X Yes X No
If YES, for how long (in years and months)?
Have you ever worked in the construction industry? X Yes X No
If YES, for how long? (in years and months)
Have you ever worked on an LNG project? X Yes X No

If YES, which project(s)?
Have you ever worked in Darwin? X Yes X No

If YES, for how long (in years and months)?
Are you currently completing an Apprenticeship? X Yes X No

If YES, what year of your Apprenticeship are you in?
Are you interested in undertaking an apprenticeship? X Yes X No

Are you currently completing a Traineeship? X Yes X No
Are you currently in a leadership role? X Yes X No
POSITIONS
IMPORTANT: Please tick one project position you are interested in from the list below.
X Abrasive Blaster X Electrical Tradesperson Special Class X Operator - Forklift up to 2.3 tonnes
X Accountant X Electronics Tradesperson X Operator - Forklift over 2.3 tonnes
X Accounts X Emergency Response Officer X Operator - Front End Loader 2.5 m3 to 4.7m3
X Administration / Clerical X Employee Relations X Operator - Front End Loader over 4.7m3
X Administration Manager X Engineer X Operator - Front End Loader up to 2.5m3
X Apprentice Adult X Environmental Adviser X Operator - Grader Final Trim
X Apprentice Carpenter X Environmental Coordinator X Operator - Grader over 100 BHP
X Apprentice Electrical X Environmental Engineer X Operator - Pile Driver
X Apprentice Metal Trades X Environmental Manager X Operator - Pneumatic Wheel Loader - over 110kW
X Apprentice Plumber X Extinguisher Technician X Operator - Road Paving Machinery
X Boilermaker Tradesperson X Fire Alarm Technician X Operator - Roller
X Bus Driver X Formworker (Carpenter Unindentured) X Operator - Scraper over 26m3 capacity
X Cable Joiner X General Practitioner X Operator - Scraper up to 18m3 capacity
X Cable Jointer X Glazier X Operator - Tractor over 150BHP
X Carpenter Tradesperson X HSE Administrator X Operator - Tractor Pneumatic Tyred Tractor over
X Carpenters/Formsetter Assistant X HSE Advisor 110kW
X Chef X HSE Manager X Operator - Tractor Pneumatic Tyred Tractor up to
X Cladder X Human Resources Manager 110kW
X Operator - Tractor up to 150BHP
X Cleaner X Hydraulic Fitter
X Painter
X Commissioning X Industrial Relations Manager
X Paramedic
X Communication Technician X Information Technology
X Payroll
X Concrete Cutting Machinery X Instrument Tradesperson
X Physiotherapist
X Concrete Finisher/Grouter X Instrument Tradesperson Complex Systems
X Pipefitter
X Concrete Gun or Pump Operator X Instrumentation and Control Tradesperson
X Pipelayer
X Concretor X Kitchen Hand
X Planner
X Construction Manager X Labourer
X Plasterer
X Contracts Administrator X Material Controller
X Plumber
X Contracts Manager X Mechanic
X Poly Pipe Welder
X Control Systems Tradeperson X Mechanical Tradesperson
X Procurement
X Cook X Mechanical Tradesperson Special Class
X Project Controls Manager
X Cook - Breakfast X NDT Person
X Project Manager
X Cost Control X NDT Technical Officer (Staff)
X QA/QC Inspector
X Cryogenic Insulator X NDT Technician (Staff)
X Refrigeration Mechanic
X Document Control X Non-Cryogenic Insulator
X Rigger Advanced
X Dogger X Nurse (Registered)
X Rigger Basic
X Drainlayer X Operator - Backhoe
X Rigger Intermediate
X Driller X Operator - Crane Non-Slewing up to 20 tonnes
X Rope Access Technician (Rigger)
X Drilling Machine Operator X Operator - Crane over 100 tonnes
X Scaffolder Advanced
X Driver - Motor Vehicle over 1.27 tonnes X Operator - Crane Tower
X Scaffolder Basic
X Driver - Motor Vehicle over 6.09 tonnes X Operator - Crane up to 100 tonnes
X Scaffolder Intermediate
X Driver - Truck over 20 tonnes X Operator - Crane up to 20 tonnes
X Security Officer
X Driver - Truck up to 20 tonnes X Operator - Crane up to 60 tonnes
X Service Attendant
X Dual and Advanced Ticketed - Operator Crane over X Operator - Crawler Tractor 104 - 171kW
X Service Provider
100t and Advanced Rigging X Operator - Crawler Tractor over 228kW
X Dual and Advanced Ticketed - Operator Crane over X Serviceperson
X Operator - Crawler Tractor up to 67kW
100t and Advanced Scaffolding X Sheet Metal Worker
X Operator - Excavator over 100 BHP
X Dual and Advanced Ticketed - Scaffolding and Rigging Operator - Excavator up to 0.5m3 capacity X Sheet Metal Worker 2nd Class
X
X Electrical Mechanic Operator - Excavator up to 100 BHP X Steel Fixer
X
X Storeperson X Technical Services X Vacation Student
X Stress Reliever X Trades Assistant - Electrical X Warehouse Supervisor
X Superintendent X Trades Assistant - Mechanical X Welder - Tack
X Supervisor X Traffic Controller X Welder Special Class
X Surveyor X Training X Welder Tested
X Surveyors Field Assistant X Tube Fitter X Welding Inspector
Experience in position selected: ......... years ......... months
CERTIFICATIONS AND QUALIFICATIONS
Please enter details of all certifications/qualifications held.
X Certificate II
X Building and Construction
X Fire Alarms Servicing (UEE21007)
Certificate/Reference Registered Training
Number: Organisation(RTO):
Completed: (dd/mm/yyyy)
X Asset Maintenance (Fire Protection Equipment) (PRM20404)

X Other
X Drilling Operations
X Security Operations
X Process Manufacturing (MSA20107)

X Process Plant Operation (PMA20108)

X Certificate III
X Bricklaying (Housing)
X Bricklaying/Blocklaying
X Carpentry
X Civil Construction Plant Operations
X Concreting
X Flooring Technology
X Painting & Decorating

X Roof Plumbing
X Carpentry and Joinery

X Plumbing & Gas Fitting

X Refrigeration and Air Conditioning

X Electrical and Electronics

X Data and Voice Communications
X Electrical - Instrumentation
X Engineering - Electrical/ Electronic Trade

X ESI - power systems - distribution cable jointing

X Instrumentation and Control

X Food
X Hospitality (Commercial Cookery)
X Metals, Manufacturing and Services

X Engineering Fabrication (Boilermaking/ Welding)
X Engineering - Fabrication Trade (Light Fabrication - Sheetmetal)

X Engineering - Mechanical
X Other
X Drilling Operation
X Mine Emergency Response and Rescue

X Frontline Management
X Hazardous Areas
X Transport and Logistics (Warehousing and Storage)

X Certificate IV
X Electrical - Rail Signalling
X Engineering - Electrical/ Electronic Trade

X Electrical - Instrumentation
X Instrumentation and Control

X Food
X Hospitality (Commercial Cookery)

X Engineering - Mechanical
X Other
X Health Care (Ambulance)
X Training and Assessment

X Transport and Logistics (Rail Operations)

X Frontline Management
X Hazardous Areas
X Occupational Health & Safety

X Transport and Logistics (Warehousing and Storage)

X Certification in Non-Destructive Testing

X Certification in Non-Destructive Testing Level 2
X Certification in Non-Destructive Testing Level 3

X Dangerous Goods and Explosives

X SA Blasters Licence
Certificate/Reference Expires: (dd/mm/yyyy)
Number:
X Provisional (trainee) X Underground
X Quarrying
X SA Dangerous Goods Driver Licence

Number:
X Class 2 X Class 6
X Class 3 X Class 8
X Class 4 X Class 9
X Class 5
X SA Licence to Carry Explosives

Number:
X Carry over 1000kg X Carry up to 265kg
X Carry up to 1000kg X Carry up to 60kg
X Dangerous Goods
X Bulk Dangerous Goods Drivers Licence
Number:
State Certified:
X Explosives Drivers Licence

Number:
State Certified:
X WA Dangerous Goods Security Card

Card Number: Expires: (dd/mm/yyyy)
X WA Shotfirer Permit
Number:
X QLD Licence to Transport Explosives

Number:
X Ammunition X Class 5.1
X Blasting Explosives X Fireworks
X Class 1 Category 1 X Propellant Powders
X Class 1 Category 2 X SSAN
X Class 1 Category 3
X Other Class
Details:
X Other
Details:
X QLD Licence to Use Explosives

Number:
X Ammunition X Propellant Powders
X Blasting Explosives X Pyrotechnics
X Fireworks X SSAN
X Other
Details:
X QLD Shotfirer Licence

Number:
X Agricultural/Seismic/Small Scale Blasting X Class D - Construction - Above Ground
X Quarrying/Opencut Mining/Construction X Class E - Seismic - Above Ground
X Tunnelling and Underground Mining X Class F - Coal - Under Ground
X Class A - Agricultural X Class G - Metal - Under Ground
X Class B - Open Cut (Metalliferous and Coal) - Above Ground X Class H - Construction and Tunnelling - Under Ground
X Class C - Quarrying - Above Ground
X Other
Details:
X Driver Training
X Drive and recover a 4WD vehicle (SISODRV302A)
Certificate/Reference Details:
Number:
X Operate 4WD vehicle (TLIC2025A)

Number:
X Operate a Commercial Vehicle (TLIC1051A)

Number:
X 2WD Driver Training

Number:
X 4WD Driver Training

Number:
X Operate & Maintain a 4WD (RIIVEH305A)

Number:
X Drive & Recover a 4WD (SRODRV001B)

Number:
X Operate a 4WD in Rugged Terrain (SRODRV002B)

Number:
X Advanced Recovery Techniques (SRODRV003B)

Number:
X Defensive Driving (TLIC107C)

Number:
X Defensive Driving on Gravel Road (TLIC107C)

Number:
X Operator Light Weight Vehicle (RIIVEH201A)
Number:
X Drivers Licence
Number:
State Certified:
X Large Passenger Vehicle Driver Accreditation X R-N (Moped)

X C (Car) X R-E (Motorcycle max 250cc)
X LR (Light Rigid) X R (Motorcycle)
X MR (Medium Rigid) X T (Taxi Licence Extension)
X HR (Heavy Rigid) X F Endorsement Commercial Passenger Vehicle (Bus)
X HC (Heavy Combination) X H Endorsement Commercial Passenger Vehicle
X MC (Multi Combination)
X QLD Driver Authorisation
X Courtesy and Community services X Motorcycle Tour services

X General services X Scheduled services
X Limousine service X Taxi service
X Electrical Licence NT
Number:
X A Grade Licence
X Electrical Cable Jointer X Electrical Linesperson

X Electrical Fitter X Electrical Mechanic
X Restricted Electrical Licence
X Disconnection and Reconnection (Basic) X Pre-assembled Neon Signs

X Domestic Appliances and Equipment X Refrigeration and Air-conditioning Equipment
X Explosion Protection Equipment X Self Propelled High-voltage Earthmoving Equipment
X Gas Equipment X Specialised Commercial/Industrial Equipment
X Instrumentation and Control Equipment X Water Plumbing
X Plug and Cord Connected Equipment
X First Aid
Number:
Expires: (dd/mm/yyyy)
X CPR / Low Voltage Rescue (Switchboard Rescue) X Industrial Health Care - PM / Paramedic (Industrial Paramedic)
X Perform CPR (HLTCPR201A) X Remote Area First Aid
X Emergency First Aid (Introductory First Aid) X Senior First Aid
X Industrial Health Care - ER / Emergency Response (Industrial Ambulance Care) X Basic Workplace First Aid (Worksafe Level 1)
X Industrial Health Care - OER / Offshore Emergency Response X Workplace First Aid (Worksafe Level 2)
X Industrial Health Care - OP / Offshore Paramedic X Occupational First Aid (Worksafe Level 3)
X Gasfitting Licence NT
Number:
X Autogas X Provisional
X Domestic
X High Risk Work Licence (WorkSafe Certificate)

Certificate/Reference Issued Date: (dd/mm/yyyy)
Number:
Expires: (dd/mm/yyyy)
State Certified:
X CS - Self Erecting Tower Crane X SB - Basic Scaffolding

X C2 - Slewing Mobile Crane Operation (up to 20T) X SI - Intermediate Scaffolding
X C6 - Slewing Mobile Crane Operation (up to 60T) X SA - Advanced Scaffolding
X C1 - Slewing Mobile Crane Operation (up to 100T) X PB - Concrete-placing Boom Operation
X C0 - Slewing Mobile Crane Operation (Open/Greater than 100T) X WP - Boom-type Elevating Work Platform
X CN - Non-slewing Mobile Crane Operation (Greater than 3T) X HM - Material Hoist Operation (Cantilever Platform)
X CT - Tower Crane Operation X HP - Hoist Operation (Personnel & Materials)
X CD - Derrick Crane Operation X LF - Forklift Truck Operation
X CP - Portal Boom Crane Operation X LO - Order-picking Forklift Truck
X CB - Bridge & Gantry Crane Operation X BB - Basic Boiler Operation
X CV - Vehicle-loading Crane Operation (10T or Greater) X BI - Intermediate Boiler Operation
X DG - Dogging X BA - Advance Boiler Operation
X RB - Basic Rigging X ES - Reciprocating Steam Engine Operation
X RI - Intermediate Rigging X TO - Turbine Operation
X RA - Advanced Rigging
X Highest Education Level
Institution & Course Completed: (dd/mm/yyyy)
Name:
State Certified:
X High School X Diploma / Certificate

X Trade Certification X Bachelor Degree
X Certificate IV X Masters Degree
X Diploma X PhD
X Maritime Security Identification Card (MSIC)

X Application for MSIC Submitted (Card NOT Yet Received)
MSIC Number: Application Date: (dd/mm/yyyy)
X MSIC Issued (Card Received)

MSIC Card Number: Expires: (dd/mm/yyyy)
X Medical Practitioner Registration

Number:
State Certified:
X Mobile Plant Operation

Number:
X Haul Truck Operation X Grader Operator

X Dozer Operator X Roller Operator
X Dump Truck (Rigid or Articulated) X Scraper Operator
X Excavator Operator X Skid Steer Loader Operator
X Front End Loader / Backhoe Operator X Water Cart Operator
X Front End Loader Operator
X Other
Details:
X Nurse Registration
Number:
State Certified:
X Nurse (EN) X Nurse (RN)
X OHS Construction Induction Card

Certificate/Reference Issued Date: (dd/mm/yyyy)
Number:
State Certified:
X Passport
Passport Number: Expires: (dd/mm/yyyy)
Country of Issue:
X Plumber Licence NT
Number:
X Advanced Tradesman Licence
X Drainer X Plumber & Drainer

X Plumber
X Journeyman Registration
X Drainer X Plumber & Drainer

X Plumber
X Radiation Safety Licence

Number:
State Certified:
X Compliance Testing - Fixed Radiation Gauges X Radioactive Ores - Mining and/or Processing
X Gauges - Fixed Industrial X Radiography - Industrial
X Gauges - Logging X X-ray Analysis
X Gauges - Portable Density/Moisture
X Other
Please specify:
X Security Licence NT
Number:
X Crowd Controller Licence X Security Officer Licence
X Dual Licence - Security Officer & Crowd Controller
X Trades Certificates/Qualifications
X Automotive
X Automotive Electrician
Certificate Number: Issued Date: (dd/mm/yyyy)
State Certified:
X Automotive Technician (Light)

State Certified:
X Automotive Technician (Heavy)

State Certified:
X Automotive Technician (Marine Light)

State Certified:
X Automotive Technician (Motor Cycle)

State Certified:
X Automotive Technician (Outdoor Power Equipment)

State Certified:
X Panel Beater
Certificate Number: Completed: (dd/mm/yyyy)
State Certified:

X Bricklaying
State Certified:
X Bricklaying (Housing)
State Certified:
X Carpentry (Housing)
State Certified:
X Carpentry and Joinery

State Certified:
X Carpentry Fixing (Housing)

State Certified:
X Carpentry Formwork (Housing)
State Certified:
X Carpentry Framing (Housing)

State Certified:
X Drainer
State Certified:
X Floor Finishing
State Certified:
X Joinery (Housing)
State Certified:
X Painting (Housing)
State Certified:
X Painting and Decorating

State Certified:
X Plastering
State Certified:
X Plastering (Housing)
State Certified:
X Plumbing and Gasfitting

State Certified:
X Roof Plumbing
State Certified:
X Roof Tiling
State Certified:
X Sprinkler Fitting
State Certified:
X Steel Framing (Housing)

State Certified:
X Wall and Ceiling Fixing (Housing)

State Certified:
X Wall and Floor Tiling
State Certified:

X Electrical (Appliance Servicing)
Certificate/Reference Completed: (dd/mm/yyyy)
Number:
State Certified:
X Electrical (Electrical Machine Repair)

Number:
State Certified:
X Electrical (Rail Signalling)

Number:
State Certified:
X Electrical (Switchgear and Control Gear)

Number:
State Certified:
X Electricity Supply Industry Generation (Operations)

Number:
State Certified:
X Electricity Supply Industry Generation (System Operations)

Number:
State Certified:
X Electronic (Communications)
Number:
State Certified:
X Electronic (Computer Systems)

Number:
State Certified:
X Electronic (Data Communications

Number:
State Certified:
X Electronic (Instrumentation and Control)

Number:
State Certified:
X Cable Jointer
State Certified:
X Electrical
State Certified:
X Electrical Powerline
State Certified:
X Electronic Instrument
State Certified:
X Food
X Chef
State Certified:

X Fitter and Machinist
State Certified:
X General Fabrication Engineering

State Certified:
X General Mechanical Engineering

State Certified:
X Mechanical Fitter
State Certified:
X Metal Fabrication
State Certified:
X Metal Machinist
State Certified:
X Refrigeration and Airconditioning Mechanic

State Certified:
X Sheetmetal Work
State Certified:
X Welding
State Certified:
X Other Trades
X Driller
State Certified:
X Communications
X Telecommunications Networks
Number:
State Certified:
X Traffic Controller NT
X WZ1 Traffic Management Plan Designer
Number:
X WZ2 Traffic Controller

Number:
X WZ3 WorkzoneTraffic Supervisor

Number:
X Unit of Competency
X Other
X Gas Test Atmospheres
Number:
X Plastics, Rubber And Cablemaking

X Butt weld polyethylene plastic pipelines
Number:
X Electrofusion weld polyethylene pipelines

Number:
X Roof Plumbing
X CPCPRF2002A Cladder
Number:
X Visa
Certificate/Reference Class/Subclass (AA/
Number: 111):
Issue Date: (dd/mm/yyyy) Expires: (dd/mm/yyyy)
X 457 X Other
X Permanent Resident
X Welding Certification
Certificate/Reference
Number:
X Gas Metal Arc Welding (G.M.A.W.)

Expires: (dd/mm/yyyy) State Certified:
X Pipe X Structural
X Gas Shielded Flux Core

X Pipe X Structural
X Manual Metal Arc Welding (M.M.A.W.)

X Pipe X Structural
X Stick Electrodes
X Pipe X Structural
X Sub Arc Welding

X Pipe X Structural
X Tig
X Pipe X Structural
X Tungsten Arc Welding (G.T.A.W.)

X Pipe X Structural
X Other
Details: Expires: (dd/mm/yyyy)
State Certified:
HEALTH
IMPORTANT: A previous Workers' Compensation claim is not a barrier to the consideration of an application for employment. To assist in
assessing opportunities for placement in appropriate employment, please complete this section accurately.
IMPORTANT: The information provided in this section may be made available to an insurer in connection with any claim for workers
compensation. A worker may not be eligible for compensation for an injury or disability sustained in the workplace where it is
proved that the worker made wilful and false representations as not having previously sustained the injury or disability at the
time of seeking or entering employment. Therefore, it is important that your answers are correct.
Have you ever made a claim for Worker's Compensation? X Yes X No
If YES, please provide details:
Description of Injury or Disability Date Occurred (dd/mm/yyyy) Duration Employer
A disability or injury is not a barrier to the consideration of an application for employment. To assist in assessing opportunities for placement
in appropriate employment, please complete the following:
Do you have a disability, injury, illness or condition that may affect any aspect of your work performance or that may be X Yes X No
aggravated or accelerated by the type of work you are applying for?
If you answered 'YES' to the above; please provide details:
Are you currently taking any prescribed medications? X Yes X No

Do you have any allergies? X Yes X No

Do you wear contact lenses or prescription glasses? X Yes X No
EMPLOYMENT HISTORY
Beginning with your current or most recent employment, please provide details of the last five years including any periods of unemployment.
IMPORTANT: We will contact any of your previous employers shown below for the purpose of confirming your employment details and
determining your suitability for employment.
May we also contact your current employer? X Yes X No
Start date: (dd/mm/yyyy) End date: (dd/mm/yyyy)
Company name: Position held:

Location/project: Name of supervisor:
Telephone number(s): Main duties and
responsibilities:
Reasons for leaving:

responsibilities:

responsibilities:

responsibilities:

responsibilities:

responsibilities:

responsibilities:

responsibilities:
PREVIOUS EMPLOYMENT HISTORY

If there was insufficient room above to cover the last five years then please provide further information here.
Company Name Position Held Name of Supervisor Telephone Number(s) Employment Dates (month/year) Location/Project
PLEASE TELL US MORE ABOUT YOURSELF
If you have had any experience in Leading Hand, Supervisory or Leadership roles, please detail all relevant information.
What, in your experience, is the best way to go about correcting or making safe a work area that has hazards?
What do you believe to be the most important thing that helps create a safe working environment?
What do you believe is the best way to resolve any work related issues or grievances?
In order of priority, list who is accountable for your safety: Employer, Yourself, Work mates, Worksafe.
-- End of form --
DECLARATION OF USUAL PLACE OF RESIDENCE
I _____________________________________________ (full name)

understand they my Declaration of Usual Place of Residence determines my
right to entitlements / allowances either as a Local or Non Local employee in
accordance with the AMJV Ichthys Onshore Construction Greenfields
Agreement .
Once established, my residency status as a Local Employee may not be
changed during my employment on the Project. My usual place of residence
must be the same address as my address listed on my JKC Registration of
Interest form.
In accordance with the AMJV Ichthys Onshore Construction Greenfields
Agreement (the ‘Agreement’), I hereby acknowledge:
 the terms and conditions of employment as per the Agreement are
applicable to local and non-local employees employed on the Ichthys
Project and those terms differ depending on your status;
 that my usual place of residence, as defined in the Agreement, is within
the eighty (80) kilometre radius line of the Ichthys Project Site and I am
therefore classified as a Local Employee; and
 that this Declaration will determine my status, for the duration of my
employment on the Ichthys Project, as a Local Employee for the
purposes of the Project.
I _____________________________________________ (full name), declare

that my usual place of residence (as per my JKC Registration of Interest form)
is:
Street: ________________________________________________________
Suburb: __________________ State:_____________ Post Code: __________
Signed: ______________________________ Date: _____________________

West Perth WA 6005 Australia
T +61 8 6210 4500
F +61 8 6210 4501
AMJV ICHTHYS ONSHORE LNG PROJECT
Planned Leave Declaration Form
Please complete the below to assist us with your Recruitment & Mobilisation process.
As the Ichthys Project is manning up and will soon be at its peak construction phase, it
is mandatory that you declare any planned leave outside of the standard 7 days RnR
so that this can be considered by the Project Management team.
Name Position
Do you have any holidays booked in the next 12 months: Yes No
If Yes, Please provide dates from: Date to
* Please note, completing this form does not acknowledge that this leave period
is approved. On your arrival to site you will be required to complete a Leave
Request Form and discuss this with your Supervisor*
Candidate Signed Date
Recruitment Signed Date

Consultant

West Perth WA 6005 Australia
T +61 8 6210 4500
F +61 8 6210 4501
E info@agc-ausgroup.com
www.agc-ausgroup.com
AGC Industries Pty Ltd
AMJV Ichthys - Planned Leave Declaration Form ABN 57 079 939 898
Proof of Entitlement to Work in Australia
Applicant
Surname: Position:
Given Names: Location:
Date of Birth: Date:
Immigration Status
Australian Resident citizen
Australian Permanent Resident
New Zealand Citizen who entered Australia on a valid NZ Passport
Non-Citizen holding a valid visa with work rights
Visa Class and Subclass Date Issued Duration of Visa years months
Evidence of Work Rights
No other documents are acceptable as proof of work rights.

One of the following documents must be sighted and a signed copy be kept on file
Australian Birth Certificate
Australian Citizenship Certificate
Australian Passport
Passport Number: Country of Issue:
Certificate of Evidence of Resident Status

Valid Visa with Work Rights
Authority to verify working rights in Australia:

By signing this form I give permission for AusGroup Limited, to conduct a Visa Entitlement Verification Online
(VEVO) check to validate my visa entitlements and status.
I also authorise the Department of Immigration and Citizenship (DIAC) to release the details of my work rights
status (that is, my entitlement to work legally in Australia) to AGC AusGroup.
I understand that these details are held by (DIAC) on departmental files and computer systems. I also
understand that AusGroup Limited will use this information for the purposes of establishing my legal
entitlement to work in Australia, and for no other purpose.
I understand that VEVO is a free online service that gives visa holders, employers and other registered
organisations access to visa entitlement and status information. http://www.immi.gov.au/e_visa/vevo.htm
Applicant/Employee Signature: Date:
Office Use Only
Date:
People Capital - Authorised Officer Signature
Form Number: B4001-PC-FM-029-AUS Rev: 2 Page 1 of 1

AMJV Clothing Request (PPE)
Employee Details
Employee Name Position
Project Name Site
Project Number
Clothing Order
Provided that you have an entitlement to the supply of protective clothing and boots, you shall be supplied the following:
 One pair of steel capped boots; plus
 Six long sleeve shirts and four pairs of trousers OR six pairs of overalls.
It is essential that you provide your correct sizing; ordering further clothing will take additional time and may delay your mobilisation.
Special size orders cannot be returned. If you are unsure of your sizing, please contact your Recruitment Consultant.
Size Details
Item
Preferred clothing Shirt & Trousers or Overalls (please tick ONE only)
Hi-Vis Long Sleeve Shirt Size:

Aust Standard w reflective strips, Quantity: (will receive 3 unless otherwise noted)
AMJV & Perfect Day Logo’s
Item Number: (see 2nd pg for No.)
Pants / Overalls Aust Size:

Standard w Reflective strips, Quantity: (will receive 3 unless otherwise noted)
AMJV & Perfect Day Logos
Steel Capped Boots (provide Size:

AU size)
AMJV Back Pack Item Number: 220074

Full Time & Fixed Term Staff
only New Hire more than 6months Previous AGC Emp
Note: Employment term must be greater than 6 months and 1 off issue per
employee
Prescription Protective Eye Yes No
Wear Required (if applicable (If Yes, you must provide your Recruitment Consultant with a copy of your latest prescription. All prescriptions
to your project) must have been issued within the last 12 Months)
Deliver to/Collect From -
Location: Date Required:
Approval
Please ensure that this form is completed in full and returned to your Supervisor or Recruiter as soon as possible. All size
information must be completed prior to returning this form.
Employee Signature Date
Authorised Signature Date

Email completed form to: clothingrequests@agc-ausgroup.com
Purchasing use only: Date Received: ____________ Move Order No. _______ Entered by: ________________

AMJV Clothing Request (PPE)
Sizing information:
If the size you require is not listed, please contact Purchasing for assistance.

Employee On-boarding Induction/Training Request
Part A - Unique Student Identifier (USI) (all fields are MANDATORY)

The USI is part of the way that the Australian Government is improving the training sector. This will ensure that
you can obtain a complete record of your enrolments and achievements from a single online source. You must
have registered for the USI in order to receive Certificates, Statement of Attainments or Transcripts for your
training.
Please register for your Unique Student Identifier Number at the following website www.usi.gov.au
For help, phone: 13 38 73
If the USI is not received, you will not be booked for your required training.
Participant Information
Mr. Mrs. Miss Ms. Surname: First Name: Middle Name:
Unique Student Identifier (USI) Number:
D.O.B.: / / Country of birth: Gender: M F
Are you an Australian Citizen? Yes No
Language
What language do you speak at home: English Other please specify:
How well do you speak English: Very well Well Not well Very Little
Special Needs / Disability

Do you have any condition that could hinder your learning capacity?: No Yes (if yes, specify below)
Details:
Acquired Brain Injury Mental Illness Learning disability ea

Medical Condition Physical Disability Reading/ writing ea
Impaired Hearing Impaired Vision Other:
In Case of Emergency
Next of Kin Name: Relationship to you: Mobile ph:
Address: Home/Work ph:
Applicant Signature: Date:
Form Number: AGMS-PC-FM-016-AUS Rev: 1 Page 1 of 4

Journey Plan
Details
Section A and B: Is to be completed by all FIFO employees.
Section C: Is to be completed by FIFO employees that request to drive from Point of Hire (POH) to Darwin as
part of their mobilisation and/or demobilisation.
Full Name
Home Address
POH Airport
Section A - Method of Transport Part 1
From Your Home Taxi Public Transport Dropped off by Family

Address to POH I will be driving myself from my home to my POH airport
Airport
If you have ticked () this method Please Complete Section B
Taxi Public Transport Picked up by Family
From POH Airport to
your Home Address I will be driving myself from my home to my POH airport
If you have ticked () this method Please Complete Section B
Section B - Method of Transport Part 2
Proposed rest breaks and/or other to be provided below:

Expected Duration of drive from
Eg: I stay at my brother’s house 30 minutes from airport and travel to home the
POH Airport to Home address
next morning.
Please () tick box below
Eg: I take 15 minutes breaks every 2 hours while driving
Less than 1 hr or (less than 100km) For less than 100km travel, rest breaks are encouraged if needed
1hr to 2hrs or (approx. 100 to 200 Km)
2hrs+ or (approx. 200km+)
Authorisation
I _____________________________________________ (full name) will adhere to the Journey Plan as

indicated above and ensure that I return home in a safe and controlled manner.
Employee Full Name Signature Date
Once completed please send to AGCIchthys.Recruitment@agc-ausgroup.com Site HR Received
Project Document Number: B4001-HS-FRM-001 Rev: 2 Page 1 of 2

Journey Plan
Section C - Driving Journey Plan

Where an employee requests to drive from POH to Project or from Project to POH the following details MUST
be provided and approved by HSES Manager prior to travel.
Reason for Travel
Journey From Journey To
Date of Departure Date of Arrival
Approx. Time of Departure Approx. Time of Arrival
No. of Passengers (excl driver) Registration No. of Vehicle
Night Driving Required Yes No
Proposed Route (List Places of Proposed Route):
Stop 1 Stop 6
Stop 2 Stop 7
Stop 3 Stop 8
Stop 4 Stop 9
Stop 5 Stop 10
Authorisation
I _____________________________________________ (full name) understand that the information declared

in regards to my journey plan is true and correct to the best of my knowledge.
Employee Full Name Signature Date
HSES Manager Signature Date
Once completed please send to AGCIchthys.Recruitment@agc-ausgroup.com Site HR Received
Project Document Number: B4001-HS-FRM-001 Rev: 2 Page 2 of 2

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AMJV APPLICATION CHECKLIST

Registration of Interest Form

Usual Place of Residence

Planned Leave Declaration Form

Proof of Entitlement Form

Training Registration Form

Tickets and Licences

Passport or Australian Birth Certificate

NOTE: - No electronic signatures will be accepted on the paperwork

1. Complete all sections. Incomplete forms cannot be processed.

FITNESS FOR WORK

OTHER PROJECT REQUIREMENTS

DECLARATION OF USUAL PLACE OF RESIDENCE

I, declare that my usual place of residence is:

I, have read, understood and agree to the terms outlined in

RETURN THIS FORM TO

AMJV (AGC Industries & Meisei Industrial Joint Venture)

Title: X Mr X Ms X Mrs X Miss X Dr X Prof

USUAL PLACE OF RESIDENCE

EMERGENCY CONTACT INFORMATION

USUAL PLACE OF RESIDENCE

EMERGENCY CONTACT INFORMATION (OPTIONAL)

USUAL PLACE OF RESIDENCE

Have you ever worked on an LNG project? X Yes X No

Have you ever worked in Darwin? X Yes X No

Are you currently completing an Apprenticeship? X Yes X No

Are you interested in undertaking an apprenticeship? X Yes X No

Experience in position selected: ......... years ......... months

CERTIFICATIONS AND QUALIFICATIONS

Please enter details of all certifications/qualifications held.

X Asset Maintenance (Fire Protection Equipment) (PRM20404)

X Process Manufacturing (MSA20107)

X Process Plant Operation (PMA20108)

X Painting & Decorating

X Carpentry and Joinery

X Plumbing & Gas Fitting

X Refrigeration and Air Conditioning

X Electrical and Electronics

X Engineering - Electrical/ Electronic Trade

X ESI - power systems - distribution cable jointing

X Instrumentation and Control

X Metals, Manufacturing and Services

X Engineering - Fabrication Trade (Light Fabrication - Sheetmetal)

X Mine Emergency Response and Rescue

X Transport and Logistics (Warehousing and Storage)

X Engineering - Electrical/ Electronic Trade

X Instrumentation and Control

X Metals, Manufacturing and Services

X Training and Assessment

X Transport and Logistics (Rail Operations)

X Occupational Health & Safety

X Transport and Logistics (Warehousing and Storage)

X Certification in Non-Destructive Testing

X Certification in Non-Destructive Testing Level 3

X Dangerous Goods and Explosives

X SA Dangerous Goods Driver Licence

X SA Licence to Carry Explosives

X Explosives Drivers Licence

X WA Dangerous Goods Security Card

X QLD Licence to Transport Explosives

X QLD Licence to Use Explosives

X QLD Shotfirer Licence

X Operate 4WD vehicle (TLIC2025A)

X Operate a Commercial Vehicle (TLIC1051A)