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Application for Employment  

This application form is to be completed personally by the applicant. The completion of this form does not indicate any obligations on this employer to engage the applicant

 
 
Do you consent under the Privacy Act 1993, to this employer contacting your existing/former employers or referees and retaining this information on file for this employer's exclusive use? Yes          No 
   
You may attach any other information to this form which you consider relevant, e.g. curriculum vitae, qualification certificates etc...  

Position Details

 
Position applied for  
Available start date  
Personal Details  
Surname  *essential
Given Names  *essential
Specify any other name known by  
Address  
Telephone Number  *essential
Email  *essential
Person to contact in event of emergency  
Name  
Address  
Telephone Number  
Employment Status  
Are you legally entitled to work in New Zealand?  Yes          No
Education  
Secondary School attended  
Qualifications gained  
   
Tertiary Institution attended  
Qualifications gained  
   
Any other study?  
Employment History  
Present or most recent employer  
Address  
Telephone Number  
Position held by applicant  
Main duties  
Reason for leaving  
   
Next most recent employer  
Address  
Telephone Number  
Position held by applicant  
Main duties  
Reason for leaving  
Referees  
Name  
Relationship to applicant  
Address  
Telephone  
   
Name  
Relationship to applicant  
Address  
Telephone  
General  
Have you ever 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, what class?  
Drivers Licence Number  
Do you have any demerit points or endorsements?  Yes          No
If yes, please detail  
Are you a member of any territorial force unit?  Yes          No
If so, have you completed whole time training?  Yes          No
What are your interests/hobbies/sports/clubs or community activities?  
Do you have secondary employment?  Yes          No
If yes, please detail  
Is there any impediment to you travelling away or working additional hours, shifts or on weekends or public holidays?  Yes          No
If yes, please detail  
Declaration  
Do you declare that to the best of your knowledge the answers given in this application are correct and that you understand that if any false or deliberately misleading information is given, or any material fact is suppressed, that you will not be accepted, or if you are employed, your employment will be terminated.    Yes          No
   
 

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