Pacific Simulators

BULLETIN

	Position
1.	Job Position:	*
2.	Advertisement code:
3.	Date Advertised:	*
4.	I am able to start: (DD/MM/YYYY):
5.	Employment Type:	*

	Personal
7.	First Name:	*
8.	Surname:	*
9.	Preferred Name:
10.	E-Mail:	*
11.	Address:
12.	Country	*
13.	Home Phone:	*
14.	Work Phone:
15.	Mobile:
16.	Date of birth (optional):

	Current
17.	Employed by:
18.	Time there:
19.	Reason for leaving:
20.	What can I offer in this role:	*
21.	Relevant qualifications/experience: If applying for an instructor's role please be specific on your knowledge on the B737 and Microsoft FS, etc...	*
22.	Referees if appropriate:
23.	Other personal interests/past times/ hobbies:


We would appreciate you taking a few minutes to answer the following questions:

24.	Can you confirm you are legally entitled to work in the country you seek this position?	Yes No*
25.	Do you have any health or other condition or circumstances that may affect your ability to carry out all the duties of the position applied for?	Yes No*
26.	Are there any positions, or types of positions for which you should not be considered, or job duties you cannot perform because of a disability?	Yes No*
27.	Have you ever had an injury or medical condition caused by a gradual process, disease or infection – for example hearing loss, sensitivity to chemicals, repetitive strain injuries – which the tasks of the position applied for may aggravate or contribute to?	Yes No*
28.	Do you have any medical or surgical condition or disability, or mental disorder, which may impact upon your ability to effectively carry out all the duties required of you, or which may pose a risk to your health and safety, or that of other employees or members of the public with whom you will come into contact in the course of your duties?	Yes No*
	If you have answered YES to any of the above questions 2-5, please provide further information below:
29.	Is there anything else your employer should know that might affect your ability to carry out any work duties? If yes, please specify	Yes No*
30.	Have you had any criminal convictions, or been subject to an investigation for dishonesty by a previous employer, or been dismissed from any previous employment? If yes, please specify	Yes No*
31.	Have you ever had a complaint registered against you with a Professional Body, or have you ever been investigated by a Professional Body? If yes, please specify	Yes No*
32.	Will you or have you any restraint of trade requirements in markets or industries which must be met? If yes, please specify	Yes No*

33.	I have read, understood and agreed with the Declaration and Authorisation	Yes No*