Fields marked with * are required.

Personal Details

Skills / Experience

e.g. any qualifications
e.g. tractor driving, managing staff, first aid

Work Permit

The following file types can be uploaded: PDF, Word Docs (DOC, DOCX).

Uploaded Files
No files currently uploaded

Police Record

Employment Requirements

Depending on the time of year and produce demand weekend work is required.

Employment History

Latest/Present Employer

enter year
enter year

Previous Employer

enter year
enter year


Referee 1

cannot be a relative
if this person is a previous employer

Referee 2

cannot be a relative
if this person is a previous employer

Pre Employment Health Questionnaire

The intention of this questionnaire is to assess your ability to sustain the physical activity of this position.


Eye Sight



Drug/Alcohol Testing

Random drug/alcohol testing is done here, you may be required to do a test prior to being employed, if you are being employed to operate a company vehicle you will be required to pass a test prior to your employment.


If yes a letter must be provided from a medical practitioner.


Health Declaration

I agree to complete this health questionnaire and if requested, I will also be available for a health assessment by an Occupational Health Nurse or Physician appointed by Pypers Produce. I undertake to give true and complete answers in regard to my past and present health. I will not withhold any relevant information concerning this matter. Any information given, known to be untrue may exclude me from employment or may be grounds for dismissal following my appointment. I understand that any workers compensation claim arising from such information will be disputed. I understand that this record will remain confidential to Pypers Produce.

Application Declaration

I declare that the information I have given on this application form is true and correct and I have not withheld any information that is relevant to this application. I give permission for the referees listed above to be contacted to gain information regarding my work history or as a character reference.