Application for employment

First Name/s *

Last Name *

Email Address *

Do you have secondary employment? * YesNo

Secondary Employment Details

If your application is successful when could you commence employment? *

Once I supply my reference details I consent to the Company seeking verbal or written information on a confidential basis about me from representatives of my previous and/or current 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 for which I am applying. I understand that the information received by the Company is supplied in confidence as evaluative material and will not be disclosed to me. * YesNo

General

Are you prepared to work shifts if required to do so? * YesNo

Have you worked shifts before? * YesNo

Are you prepared to work overtime if required? * YesNo

Are you legally entitled to work in New Zealand? * YesNo

Have you been convicted of a criminal offence? * YesNo

Please note that under the Criminal Records (Clean Slate) Act 2004, you are not required to disclose certain criminal convictions.

Are you awaiting the hearing of charges in a civil or criminal court of law? * YesNo

Are you prepared to handle all products, materials, or equipment used in the industry? * YesNo

Do you have a spouse, partner or household-member working here or elsewhere in the industry? * YesNo

If yes, please enter their name

If yes, please enter their location

What are your interests/hobbies/sports/clubs or community activities? *

Driving History Details

Do you have a current drivers license? * YesNo

Drivers License Number

Expiry Date

Drivers License Class
—Please choose an option—LearnersRestrictedFull

Types of vehicles driven

Other Categories of License

Have you ever had any driving related offences of any kind? * YesNo

If yes, please provide details

Medical History

Have you had an injury or medical condition caused by gradual process, disease or infection for example hearing loss, sensitivity to chemicals, repetitive strain injuries that may be aggravated or further contributed to by the tasks of this job? * YesNo

If yes, please provide details

Do you agree to undergo a medical examination? * YesNo

If you are offered employment, do you consent to the Company contacting ACC for the purpose of determining your claim history? * YesNo

General

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? * YesNo

Declaration

I declare that to the best of my knowledge the information supplied in this application and 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 with regards to gradual process, disease or infection can result in my loss of entitlement for any compensation from ACC.

I further understand that any offer of employment if made is conditional on my obtaining a full medical clearance through the Company's pre-employment medical, and may include checking my claim history with ACC. *

Yes

Your CV *

Cover letter