Recruitment Application Form

Online Employment Application

New World Greenmeadows, 9 Gloucester Street, Napier
Todays Date:

Day Month Year
Date
Position you are applying for:
Full Time or Part Time

Full Time Part Time
Personal Information:

Section 1
Full Name

First Name Middle Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Ph Number

Area Code Phone Number
E-mail
Birth Date (If under 16)

Month Day Year
Name of next of kin
For emergencies
Next of kin ph:

Area Code Phone Number
Drivers License Class:
Other Licenses:

Skills/Qualifications:

Section 3
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Previous Employment:

Section 4
May we contact previous employers and/or references given?

Yes No
Previous Employer
Name of Previous Employer
Position
Reason for Leaving?
Start Date

Day Month Year
Date
End Date

Day Month Year
References:

Please give details of referees whom you authorise us to contact:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email

Preferred Departments

Section 6
Please select from the following:
Please tell us the TOTAL number of hours you are able to commit to, or want to work each week:
If your application is successful, when could you commence employment?
Do you know anyone who is currently employed by this company? If yes, who?
Do you have any additional information, which you consider may assist your application?

Cover Letter & Resume (Optional):
Cover Letter
Resume
Declaration:
I have personally completed this application for employment and declare that the information provided in this application (and resume
where provided), is correct.

I understand that should I be successful in my application, falsification or deliberately misleading information, or any material suppression of information will be grounds for instant dismissal.

I also understand that any false information given in section 5, the medical portion of this form, may result in my loss of entitlement for any compensation from ACC.
Signature

Clear
Should be Empty:

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