Business Application

Complete the below form if you are interested in working with Dingo.

Business Application Form

Personal Details

Name(Required)
MM slash DD slash YYYY
Max. file size: 2 GB.
Address

Business Details

Is your business a:
Are you registered for GST?

Vehicle Details

If you have more than one vehicle, and once you have completed this form and pressed submit, please press back and reload the form, and fill in the fields again with the additional vehicle details
Max. file size: 2 GB.
Audible Park Brake Alarm fitted?
Vehicles over 4.5 GVM: When the handbreak is disengaged, and the drivers door is opened, is there an audible alarm to warn the driver?
MM slash DD slash YYYY
MM slash DD slash YYYY

Payment Details

Working Rights

Are you an Australian Citizen?
If NO: are you a permanent resident?
If NO: Do you have a Working Visa?

Emergency Contact

Emergency Contact: Name

Health

Any condition requiring heart surgery
High Blood Pressure
Heart Disease
Chest pain, angina
Head injury, spinal injury
Diabetes
Palpitations / irregular heartbeat
Abnormal shortness of breath
Stroke
Blackouts or fainting
Seizures, fits, convulsions, epilepsy
Colour blindness
Dizziness, vertigo, problems with balance
Memory loss or difficulty with attention or concentration
Other neurological or neurodevelopmental disorder
Hearing loss or deaA psychiatric illness or nervous disorder
Hearing loss or deafness or had an ear operation or use a hearing aid
Neck, back or limb disorders
Double vision, difficulty seeing
Are you taking any prescription, non-prescription or complementary medicines?
Are you currently attending a health professional for any illness, injury or disability?
Acknowledge(Required)
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