LICENCE Please list your current licences to successfully carry out this position. Licence Type Licence Number Expiry Date CURRENT EMPLOYMENT Are you a Local Government Yes - (complete Section A)  employee? No - (complete Section B)  Section A Position Title: Employment Status: Permanent Contract   Date Appointed: Section B Current Employment (Position): Current Employer: Date Commenced: HEALTH To the best of your knowledge and belief do you have a medical condition, disability or injury which may preclude you from undertaking duties of the position you are applying for?  Yes  No Applicants who have a health condition, disability or injury are invited to discuss its relevance or otherwise with the Shire. It is NOT a barrier to consideration of an application for employment. However, if it is likely to affect your work performance or could recur or be aggravated by the type of work for which you are applying you must disclose this information.
LICENCE Please list your current licences to successfully carry out this position. Licence Type Licence Number Expiry Date CURRENT EMPLOYMENT Are you a Local Government employee?  Yes - (complete Section A)  No - (complete Section B) Section A Position Title: Employment Status:  Permanent  Contract Date Appointed: Section B Current Employment (Position): Current Employer: Date Commenced: HEALTH To the best of your knowledge and belief do you have a medical condition, disability or injury which may preclude you from undertaking duties of the position you are applying for?  Yes  No Applicants who have a health condition, disability or injury are invited to discuss its relevance or otherwise with the Shire. It is NOT a barrier to consideration of an application for employment. However, if it is likely to affect your work performance or could recur or be aggravated by the type of work for which you are applying you must disclose this information.