Employment Application Form

Employment Application
Are you applying for*

An advertised position?Casual work?Would like The Verandah to hold my details for when a position is available?
Position you are applying for
Position you wish to apply for
Full Name:*

First NameLast Name
Preferred Name
Birth Date

MonthDayYear
Phone Number:*
E-mail Address:*
example@example.com
Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about the role?*

Walk-InEmployeeTrademeFacebookSeekOther (please specify)
Upload cover letter here

Cancelof
Upload CV here*

Cancelof
Are You Legally entitled to work in New Zealand*

YesNo
Are you on a work or working holiday visa ?

YesNo
Full name on passport
Country of passport
Passport No.
Visa type
Please also provide us with a copy of the visa and ensure we can view the original visa/passport it was copied from.

Cancelof
References & Employment History

Please list two (2) references that are familiar with your work life.

Present or Most Recent Employer:
Company
Position Held
Main Duties
Hours worked per week
Reason for leaving
Next Most Recent Employer
Company
Position Held
Main duties
Hours worked per week
Reason for leaving
Reference 1
Name:*

First NameLast Name
Phone Number*
Reference 2
Name:*

First NameLast Name
Phone Number*
Do you have secondary employment?*

YesNo
If yes, please detail
GENERAL
When are you available to start work?*
Pay expectation *
Per Hour Rate
Are you prepared to work shifts if required to do so?

YesNo
Have you worked shifts before?

YesNo
Have you ever been convicted of any criminal offence (except those cases where our asking you to declare them would breach the Criminal Records (Clean Slate) Act 2004)?

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

YesNo
Do you have a current NZ drivers license?*

YesNo
Licence type?*

LearnersRestrictedFull
Do you have any demerit points or endorsements?*

YesNo
Please detail
Do you have any impairment, physical or mental, that would interfere with your ability to perform the job for which you have applied?
If there are any positions or types of positions for which you should not be considered or job duties you cannot perform because of a disability, please explain
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 business in the future? Yes/No

YesNo
DECLARATION
I blanks* (full name) declare that to the best of my knowledge the answers in this application are correct and I understand that if any false or deliberately misleading information, or any material facts are suppressed, I will not be accepted, or if I am employed, my employment could be terminated. I also understand that any false information given in relation to my medical history may result in my loss of entitlement for any compensation from ACC.
Signature

Clear
Should be Empty: