Operator Register

Download a pdf version, fill out,scan and email to ops@groundbreaker.net.au or, fax (07)3852 3320

Or fill out the online form below

1. Operator Information

First Name
Last Name
Trading Name
ABN
Email Address
Mobile Number
Landline Number
Address
Street Address
Address 2
Address Line 2
City
City
State / Province / Region
State / Province / Region
Postal / Zip Code
Postal / Zip Code
Country
Country

Privacy and Emergency contact details

Doctor
Firstname
First Name
Lastname
Last Name
Doctor Telephone details
Next of Kin
Firstname
First Name
Lastname
Last Name
Next of kin Telephone details
Authority to disclose information
Firstname
First Name
Lastname
Last Name
Relationship
Phone Number

2. Preferences

Operator Preparedness to work after hours
Number of years experience
Enter a number between 0 and 99.
Please indicate your job preference
Check all that apply
Other Competencies
Shirt Size

3. Insurance, Registration and Licences

Please attach a scanned copy of Licences
Industry Blue/White Cards
Tickets

Insurance

Please Attach a scanned Copy of certificates of Currency for
Public Liability
Renewal Date
Attached documents
Machine and attachment policy number
Renewal Date
Attached documents
Personal Accident Policy number
Renewal Date
Attached documents
Life insurance Policy number
Renewal Date
Attached documents
Workers Compensation Policy number
Renewal Date
Attached documents

4. Machine Info

Number of Machines

Machine 1

Type of Machine
Brand
Model
Size
Year
Registration
Expiry
Additional Info

Attachments

Please input info on attachments

Bucket Sizes
Augar sizes
Additional Attachments/features
Others
Further information