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Have you ever suffered an injury or illness which may in some way affect your work performance? Yes No If Yes, please give details:
Do you have any allergies? Yes No If Yes, please give details:
Are you currently taking any form of medication which may affect your work performance? Yes No If Yes, please give details:
Highest Education Level achieved:
Name of Institution:
Other Qualifications: (Trade or Other Certificates, Technical or Training Courses, Special Skills)
Personal Referees:
Interests / Hobbies:
Personal characteristics you think are important and relevant to the position applied for:
Yes, I hereby certify that the above information is correct and complete to the best of my knowledge and belief. I understand that any false or misleading information could result in dismissal from this or any position for which I am employed.
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