Talk to us about how Relines South Africa can add value to your business today.

African Operations:

Johannesburg – South Africa

Phone:+27 837 810 920
Fax:08 6210 1464


Australian Operations:

Perth – Western Australia

Phone:+1300 473 546
Personal Details
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Personal Details


How did you hear about us?:

Emergency Contacts


Work Eligibility

Qualifications/Training and Licences

Employment History

Please note that any referees listed (or company listed HR departments) may be contacted as a part of our recruitment process.




Health And Fitness

It's important that you are medically fit to perform the duties associated with the position that you are applying for.

Do you agree to undergo a full pre-employment medical and/or drug screen?:

Are you currently taking any medications which may affect your ability to work in a safe capacity?:

If yes, please provide details:

Have you ever made a claim for workers compensation?:

If yes, please provide details (date, injury etc):

Do you have any current or past medical condition which may affect your ability to work in a safe capacity or which your supervisor needs to be made aware of?:

If yes, please provide details:

Do you have any allergies to anything?:

If yes, please provide details:
Do you have a Yellow Fever Vaccination Certificate?:

If yes, please provide date of vaccination:

Do you currently have or have you ever had any of the following? (please tick)

If you have ticked any of the above, please provide details:

Criminal Record

It is a requirement by many of our clients and project sites that our personnel provide a Police Clearance Certificate or undergo a Criminal Record Verification process through an independent screening company.

Do you have a criminal record or any pending cases against you?

If you have answered yes, please provide details:


I declare that the information I have provided on this form is true and correct. I understand that deliberate omission of information may subject me to instant dismissal. I authorise Relines South Africa to contact my references as listed above.

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