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Thank you for your interest in applying for a position with Allianz Global Assistance Australia. To ensure this application represents all of your skills and applicable work experience we'd appreciate if you could complete this form as thoroughly as possible.

Your application will remain valid for 90 days. Following this timeframe if you still desire a position with Allianz Global Assistance, you will need to re-apply with us. If you do not re-apply, your application will not be considered for further employment opportunities and all documentation will be confidentially destroyed.

If you are successful we will be in contact with you within 14 days after the position close date.

Today's date:	*
Position applying for: (please mark)	Casual Part-time Full-time
Position title	*

Personal details:
First name:	*	Surname:	*
Address:	*
Suburb:	*	State: *	Postcode:
Home phone:	*	Mobile:	*
Work phone:	*	Email address:	*
May we contact you at work?: * YesNo

How did you hear about this vacancy?
Source	Please tick	Please specify
Industry publication:
Recruitment agency:
Careers website:
Allianz Global Assistance website:
Allianz Global Assistance employee:
Other:

Do you have a criminal history? *	YesNo
Are you eligible for legal employment in Australia? *	YesNo
If yes, please provide details:
Are you on a working visa that is restricted? *	YesNo
If yes, please provide details:
If yes, can you provide relevant documentation to support your eligibility?	YesNo
Is there any further information (regarding change of name, use of an assumed name or nickname) that would enable more accurate verification of details of work records?	YesNo
If yes, please provide details:
Do you have any medical condition/s or are you under any medical treatment that may impact on your duties to perform this role? *	YesNo
If yes, please provide details:

Circumstances:
Are you able to start immediately? *	YesNo
If not, what is your notice period?
Have you applied for work with Allianz Global Assistance (Australia) before? *	YesNo
If so please provide details:
Salary expectations:

For shift work positions (Rostered employees only):

Allianz Global Assistance currently operates 7 days per week, 24 hours per day, 52 weeks per year. In some positions, successful applicants will be required to work on a rotating roster including weekend and night work.

Are you willing to work varied hours as outlined above? *

YesNo

Attach your resume: *