Careers

Please fill out this application and submit if you are a Support Worker with at least a Level 4 Certificate in NZ Mental Health & Wellbeing.

FORMAL APPLICATION FOR EMPLOYMENT FORM

Purpose:

This information is collected for the purpose of assessing your suitability for employment at , which may include subsequent changes in employment with the Company. The completion of this form does not indicate that there is any obligation on the Company to engage the applicant.

Information relating to unsuccessful applicants may be retained by the Company for a period of up to 12 months.

If successful, such information shall form part of the Company’s personnel records. You are entitled to access this information upon request to the Company. This note is provided in accordance with the Privacy Act 1993.


POSITION APPLIED FOR*:
DATE*:

Surname*:
Given Names (underline name used)*:
Contact Address*:
Home Ph No*
Email*:

LEGAL WORK STATUS*

Have you reached the current school leaving age? Yes / No
Have you qualified for National Superannuation? Yes / No
Are you legally entitled to work in New Zealand? Yes / No

LIST MAJOR EDUCATION ACHIEVEMENTS*

Secondary School Qualification:
University Education:
Other Education Courses:

INDUSTRY WORK EXPERIENCE*

What experience do you have within our industry?

LANGUAGES*

What language can you speak other than English?

CURRENT EMPLOYMENT (List current Employers)

Employer Location & phone no. Main work activity Length of service

CONTINUED EMPLOYMENT (List Employersyou intend continuing to work for)

List Employer(s) you intend to continue to work for and the position you will hold in the company.

Employer Position Start Time Finishing Time Total Weekly Hrs

PREVIOUS EMPLOYMENT (List previous Employers)

Employer Location Position Reason for Leaving

Have you ever worked for our company before? *Yes / No
If yes when?

REFEREES (Provide at least two referees preferably from where you have worked)

Name Phone Number Position Postal Address

I consent to the company seeking verbal or written information about me from representatives of my previous employers and/or referees and authorise the information sought to be released by them to the company for the purposes of ascertaining my suitability for the position I am applying for. I understand that the information received by the company is supplied in confidence as evaluative material and will not be disclosed to me.

Signature:
DATE:

GENERAL*

If your application is accepted when could you commence employment?
Are you prepared to work overtime if required? Yes / No
Are you prepared to work on Public Holidays if required? Yes / No
Have you been convicted of a criminal offence? Yes / No
Are you awaiting the hearing of charges in a civil or criminal court of law? Yes / No
Do you have a current drivers licence? Yes / No
If yes, Drivers Licence No. What Classes?
Do you have any demerit points or endorsements?Yes / No
If yes, please detail:
What transport arrangements do you haveto attend work?
What are your interests/hobbies/sports?

MEDICAL AND ACC INFORMATION (Please circle)*

Do you have a medical condition or disease that may affect your ability to carry out the tasks of this job? Yes / No
If yes, detail:
Are you receiving prescribed medication? Describe:
Have you stopped work as a result of an ACC claim in the past 5 years? Yes / No
If Yes, list historical injuries with the potential to effect you below:
Date of Injury Type of Physical Incapacity Duration and outcome of treatment

INFORMATION RETENTION*

Do you consent to the company retaining the information contained in this application form for the purposes of considering your suitability for any other position which may arise with this company in the future? Yes / No

DECLARATION*

    I (full name) declare that to the best of my knowledge the information in this application form and the information contained in any resume provided is correct and I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I will not be accepted, or if I am employed, my employment will be terminated. I also understand that any false information given in relation to my medical history may affect my ability to receive entitlements under the Accident Insurance Act 1998.

* --Required fields (please fill all the required fields!!)