Your Name *

First Name

Last Name

DOB *

MM

DD

YYYY

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you identify as Indigenous or Torres Straight Islander? *

Yes

No

Next of Kin / Emergency Contact Details *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you provided Hilands with a current copy of your resume? *

Yes

No

Have you provided Hilands with a current copy of your S11? *

Yes

No

Have you provided Hilands with a current copy of your CBM? *

Yes

No

Drivers License Class *

HR

MC

Expiry *

MM

DD

YYYY

Have you provided Hilands with a front & back copy of your drivers license? *

Yes

No

Have you provided Hilands with a copy of your Covid vaccination certificate? *

Yes

No

Have you provided Hilands with a current copy of your Anglo ID Card? *

If applicable

Yes

No

Do you have an RII to operate a heavy vehicle onsite? *

Yes

No