McCarthy Transport Job Application Form

McCarthy Transport Job Application Form
You should provide complete information for each question, unless otherwise advised, regardless of whether you consider it relevant to the position for which you have applied. Failure to complete this form in the manner required may result in your application being declined.

Collecting and holding personal information

The information you provide on this application for employment form will be collected and held by MTL at head office in Whanganui.

Purpose

This information is collected for the purpose of assessing your suitability for employment with MTL (this may include subsequent changes in employment within the organisation).

If your application is successful this form will be retained on your personal file. If unsuccessful it, along with your other application papers, will be destroyed after 3 months.

Your access to this information

You have a right of access to personal information and to seek any correction you think necessary to ensure accuracy. You are however advised that any request for evaluative/opinion based material held on you will be declined.

Personal Details
Name*

First NameLast Name
Preferred Name
Address*

Street Address

Street Address Line 2

CityRegion

Postal
Email
example@example.com
Phone Number

Area Code or first three digits of cell numberPhone Number
Position you are applying for
Or position you are after if no job listing
Location/Department*

Whanganui Head OfficeWhanganui EngineeringWhanganui Hub (Operators/Office Employees/Workshop)Levin (Scaling and Operators)Taranaki (Operators)Karioi Hub (Operators/Office Employees/Workshop)Masterton Hub (Operators/Office Employees/Workshop)Waipuk/Napier Hub (Operators)No preference (Operators/Workshop)
Front of Licence (required for truck operators)
Back of Licence (required for truck operators)

Employment History
Have you been previously employed by this company or in this industry?*

YesNo
Business Name*
Position in industry or most current role
Address*
Length of service*
From what date to what date...
Position*
Reason for leaving*

Education and Qualifications
Name of Education Organisation of highest qualification
Number of years attended
List other qualifications or formal attainments you consider relevant including the issuing authority e.g. Polytechnic, University or Private Training Establishment with the qualifications/standards of achievement and years of attendance:
Computer Skills - please let us know your level of computer skills
Do you have a current first aid certificate?*

YesNo

General

	Yes	No
Have you at any time taken action against a current or former employer in order to resolve an employment dispute, including personal grievance action or other employment relationship problem?
Do you intend to engage in other paid or voluntary work whilst employed in this position?
Do you have a current drivers licence?
Are you awaiting hearing of any charges for driving offences?
Do you agree to provide permission for us to check your driving information through the NZ Transport Agency driver check programme? ( a seperate form will need to be completed for this)
Have you ever been charged with or convicted of a criminal offence? (Note: You are not required to disclose any charges or convictions eligible to be suppressed under the Criminal Records (Clean Slate) Act 2004. )
Do you have or are you aware of any likely commitments which may prevent you from attending your place of employment during normal work hours or affect your availability for overtime or work-related travel (eg sports, hobbies, special interests, education, training, etc)?
Are you a member of a territorial force unit or volunteer fire brigade or other volunteer organisation?
Do you have a spouse, partner, relative or household member working in this company or elsewhere in the industry?
Do you have the legal right to work in New Zealand, either entitlement to permanent residence or a valid work permit? (Evidence will be required if you are interviewed for the position.)
Have you ever had an injury or medical condition or gradual process injury, disease or infection that may be caused by, aggravated or further contributed to by the tasks relating to the postion being applied for?
Do you have any condition which may affect your ability to effectively carry out the functions and responsibilities of the position applied for?
Do you have any condition which may affect your ability to effectively carry out the functions and responsibilities of the position applied for?
Are you allergic to, or have sensitivity to, any substances or chemicals or insects stings?
Have you ever suffered any back or shoulder injury or back shoulder strain?
Are you taking any drugs or medication?
If your application is successful do you agree to undergo pre employment alcohol and drugs blood and/or urine testing?
The position applied for may require that personal protective equipment be used/worn while carrying out tasks associated with this postion. Are you aware of any reason why you may not be able to use/wear the equipment? (Hard hat, steel cap boots, high visibilty clothing)
In accordance with company policy and/or at the direction of the company or authorised person do you agree to use/wear protective equipment?
If you are offered this position do you agree to undertake a base-line medical examination to assess your health in relation to the tasks you may be undertaking during the course of your employment?
Do you agree to the medical examination and to the company being provided with and holding this information?

Please provide details if you answered yes to any of the above questions.
(Excluding drivers licence, if you answered no please provide details)
How many days absence in your last 12 months of employment were stated by you or a medical practitioner to be due to sickness, injury and/or accident?*

0-23-56-10More than 10
If your application is accepted, when could you commence work?

MonthDayYear
Date
Do you have any additional information you consider relevant to the organisation’s decision-making concerning hiring you for this position. For example, achievements, interests, aspirations, one-off commitments (e.g. for which you will require leave) or other background information pertinent to this position etc. If so, please list below or attach such information to this application form.

Referees
Please state the details of referees you authorise us to contact to discuss your suitability for employment, preferably work related referees including your current employer.

We will not make contact with your references without advising you before hand.
Reference 1 Name*

First NameLast Name
Phone Number*

Area Code or first three digits of cell numberPhone Number
Email*
example@example.com
Occupation/Position
Reference 2 Name

First NameLast Name
Phone Number

Area Code or first three digits of cell numberPhone Number
Email
example@example.com
Occupation/Position

Declaration
I declare that to the best of my knowledge, the answers to the questions in this application are correct. I understand that if any false information is given, or any material fact suppressed, I may not be accepted for employment, or if I am employed, I may be dismissed. *

Clear
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