MPI APPLICATION FORM  - CONFIDENTIAL - Ph 03 9646 4928 or Fax (03) 9646 5403

     Apply    PART A    PART B
 
MY CONFIDENTIAL APPLICATION FORM - Part A

  

Name

Driver's Licence No

Home Street Address
Phone Home 

Phone Work

Fax No
Phone Mobile

Fax to "Attention":

Email    
 
Age

Date of Birth     

Star Sign   

Marital Status  Single Divorced Widow/er Single Parent Ex-defacto Separated
Do I have children?

If so, ages & Male or Female 

Do I smoke?

If so, how many per day? 

Do I drink alcohol?

If so, what and how often?   

Do I have a car?
My Occupation is:
My Workplace is:
My Future Plans & Ambitions:
Height Feet/ins Cms

Hair: Colour & Length 

Weight Kg Lbs

Colour Eyes 

Religion (if any)
My educational level, background and achievements:
My ethnic origin:

Country of birth: 

My likes, interests, hobbies and sports:  
My dislikes (if any):

Would you consider   meeting a light smoker?  

Do I have any health disabilities?      You need to be overall healthy.
I describe briefly my personality as:

Preferably, print blank form and complete by hand. In any case, do not overrun text boxes.  Next: PART B