Employment Application Form

Nexus Recruitment Candidate Application

Please fill the form below accurately and all parts marked with an * are required to complete
First name:*
Last name:*
Date of Birth

DayMonthYear
Date of Birth*

DayMonthYear
Date/Month/Year
Place of Birth*
MaleFemaleOther
Mobile:*

First 3 digits 02?Mobile
Landline:

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Suburb

SuburbPostcode (If known)

City
Address Suburb data

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
{address4:city}
Head shot profile photo:*

Profile photo camera or upload
Will be used for your Nexus profile and client resume Cancelof
NZ CitizenPermanent residentWork visa/permit
Working permit number:*
Visa expiry:*

DayMonthYear
Warehouse/distributionLabouringDevanningManufacturingForkliftDrivingTruckingBuilding/constructionDispatchEngineeringTradesTraffic controlAdministrationManagementOther
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Own carPublic transport
Payrate seeking*
Hourly or salary
YesNo
First vaccinationSecond vaccinationBooked vaccination
Date of second vaccination completed or intended:

DayMonthYear
Expiry of vaccine current passport:

DayMonthYear
YesNo
Date of positive test:

DayMonthYear
Please load a photo of your vaccine current card in the document section below with any other relevant certs, quals or docs would be appreciated. Thank you
No NZ licenceClass 1 learnersClass 1 restrictedClass 1 (Car) FullClass 2 learnersClass 2 FullClass 4 learnersClass 4 FullClass 5 learnersClass 5 FullRTWDGFOIVP
Driver licence number:*
Driver licence version:*
Driver licence expiry:*

DayMonthYear
OSH forkliftSitesafeConstruct safeClass A AzzyClass B AzzyFit testTCSTMSWorking at heightsHarnessEWPKnife handlingOther
OSH forklift expiry:

DayMonthYear
Date
Sitesafe passport expiry:

DayMonthYear
Date
Construct safe expiry:

DayMonthYear
Date
Fit test expiry:

DayMonthYear
Date
Other cert and qual details:
UPLOAD: Licence / Passport / ID / CV / Qualifications / Certificates:

Document loading

Cancelof
Emergency contact name:*
Emergency contact number:*
Yes the same addressNo
Emergency contact address:

Street Address

Suburb

CityPostcode (If known)

Postal / Zip Code
NONE TO DECLAREAny back injury or strainAsthmaBronchitisHerniaSkin infectionsDiabetesDermatitis or eczemaBlackouts or SeizuresHigh blood pressureStrokeHearing lossColour blindnessOccupational overuse syndromeAre you taking any regular drugs or medicationNervous or mental disorderOther
YesNo
YesNo
Criminal conviction details and year:*
YesNo
Please list the other addresses below:
YesNo
YesNo
ACC details and year:*
Work History and References
Yes, I have given a CV or attached oneNo I will give my work history and references details nowI will just give reference details only nowNone of these options apply to me
1. Company name:*
1. Position held/title:*
1. Years with the company:*
Use a decimal to add the number of months between years
1 . DATA ENTRY - Company name and Position together
YesNo
YesNo
YesNo
2. Company name:*
2. Position held/title:*
2. Years with the company:*
Use a decimal to add the number of months between years
2 . DATA ENTRY - Company name and Position together
YesNo
YesNo
YesNo
3. Company name:
3. Position held/title:
3. Years with the company:
Use a decimal to add the number of months between years
3 . DATA ENRTY - Company name and Position together
YesNo
YesNo
4. Company name:
4. Position held:
4. Years with the company:
Use a decimal to add the number of months between years
4 . DATA ENTRY - Company name and Position together
Yes I will give other details for referencesNo
1 References full name:*
References position:*
DATA ENTRY - Reference 1 name and position
Company of reference and your position or relationship to the reference:*
References contact details:*
Phone number and email if available for ease of contact
2 References full name:
References position:
DATA ENTRY - Reference 2 name and position
Company of reference and your position or relationship to the reference:
Reference 2 contact details:
Phone number and email if available for ease of contact
WARNING
You currently have 2 references entered which is all we require unless otherwise specified. Please talk or pass on any other references to your Nexus Manager directly or they will get hold of you if they have any problems.
TrademeSeekSocial mediaFacebookReferralWebsiteSignageRadioFriendOther
Declaration & Authorisation

I declare to Nexus Agoge Recruitment Limited (hereafter called Nexus Agoge) the following and authorise Nexus Agoge to collect, retain and share information for the purpose of employment.

I will advise Nexus Agoge when I am no longer seeking employment opportunities through them.

Declaration:

I declare to the best of my knowledge, the answers to the questions in this application are true, accurate, and complete. I understand that if any false information is given, or any material fact suppressed, I may not be accepted, or if I am employed, I may be dismissed without claim against Nexus Agoge or any company that I am employed by as a result of this information.

Authorisations:

I understand that Nexus Agoge, may choose to retain my CV, this application form and subsequent information, and use the information provided for the purpose of evaluating my qualifications, experience, and assessing my suitability for any employment (of any type) with itself or clients.

I also understand that all information collected in this form and in any background checks, including but not limited to those authorised below, is collected for the benefit of Nexus Agoge clients.

Reference checks: I authorise Nexus Agoge to conduct reference checks with former and / or current employers.

ACC History: I authorise Nexus Agoge to undertake an ACC history check when needed for client or for Health & Safety purposes.

Criminal History Check History: I authorise the Criminal Records Unit, Ministry of Justice, to release a copy of my criminal convictions, subject to section 7 of the Criminal Records (Clean Slate) Act 2004, for the purpose of pre-employment vetting directly to Nexus Agoge or to a Third-Party provider on behalf of Nexus Agoge.

Police Vetting: I authorise Nexus Agoge to undertake NZ Police Vetting for the purpose of assessing my suitability.

VisaView Check: I authorise Nexus Agoge to conduct checks on my passport and / or visa with Immigration New Zealand using VisaView for the purpose of confirming my eligibility to work in NZ.

Driver Check: I authorise Nexus Agoge to complete a licence check with NZ Transport Agency Waka Kotahi, and if applicable for my role, keep my licence on driver check to get notification of any changes throughout my employment.

Privacy
Nexus Agoge will take reasonable precautions in accordance with the Privacy Act 2020 to safeguard your personal information against loss, misuse or unauthorised use or disclosure. Personal information held by Nexus Agoge will not be shared for any other purposes, and you have the right to request correction and removal of that information in accordance with the Privacy Act 2020.

Nexus Agoge may disclose any information gathered from me, and the results of the background checks authorised by me to Nexus Agoge clients without any further approval to enable the client to evaluate my suitability for work.

Electronic Signature Consent:

I consent to complete the following forms, including the above declaration, using electronic signature software for the purpose of employment with Nexus Agoge Recruitment Limited.

These forms are including, but not limited to: Declaration & Authorisation, Security Check, ACC Pre-Employment Check, Casual Employment Agreement, Payroll Form, IRD330 Tax Declaration, KiwiSaver KS2 or KS10).
I would like a copy of these checks sent to me
Digital Signature*
Application date:*

DayMonthYear
If you recieve an error message on submitting below will mean some fields above require attention.
Please scroll up to find any alert messages and please add or correct the feild and press submit again.

This will take you through to the next set of required forms.

Thank you from the Nexus team
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Nexus Recruitment Candidate Application