Online Job Application


Personal Information
First names *
Family Name *
If you are known by any other names please record here
Residential Address *
Telephone Number *
Mobile Phone Number
Email *
Date of Birth
Name of education organisations attended (e.g school or training organisation) attended and highest qualification
Qualifications (including trades)/Standards of Achievement
Employment History
Name of Employer
Employer Address
Length of Service
Position Held
Nature of work
Reason for Leaving
Referees
Name
Address
Telephone
Occupation/ Position held
General
Do you agree to the company seeking information on a confidential basis about you from your referees, for the purpose of your suitability for the position you are applying for?	Present Employer Any other person Past Employer/s
Should you be employed, do you intend to engage in any other paid work whilst employed with this company?	Yes No
If yes please give details
Have you ever been charged with or convicted of a criminal offence, or placed on Police Diversion?	Yes No
Do you have or are you aware of any likely commitments, which may prevent you from attending your place of employment during company working hours or affect your ability for extra hours of work (e.g other work, special interests, education, sports)	Yes No
If yes give brief details
Are you a member of a Territorial Force unit or Volunteer Fire Brigade?	Yes No
Do you smoke at work?	Yes No
Are you prepared to abide by our work and safety rules?	Yes No
If your application for work is accepted, when could you commence employment?
Have you worked shifts before?	Yes No
Are you prepared to work shifts?	Yes No
Are you prepared to work extra hours?	Yes No
Are you prepared to work school holidays?	Yes No
Are you prepared to work as and where directed?	Yes No
Do you have the right to permanent residence in New Zealand or a valid work permit?	Yes No
Where did you hear about this vacancy?
Have you ever had an injury or medical condition by gradual process injury, disease or infection that may be aggravated by any tasks that you may be called upon to perform by this company?	Yes No
Have you ever suffered any back injury or back strain?	Yes No
Have you ever suffered from any over-use injuries e.g RSI or OOS?	Yes No
Do you have any other condition that may effect your ability to effectively carry out the functions and responsibilities of an employee?	Yes No
If you have answered yes to any of the above questions in this section, please give details
How many days absence in your last 12 months employment were stated by you or a medical practitioner to be due to sickness, injury and/or accident?	0-2 3-5 6-10 11-15 16-20 over 20 days
Additional Information
Do you have any additional information that you consider may assist you in seeking employment here?
* denotes required field