Welcome to He Poutama Rangatahi - Get Ready, Work Ready
To be part of the Get Ready, Work Ready programme, we need to know a few details about you. Please complete registration form. Once we have received your registration, we will be in contact with you to confirm your registration.
Name
*
First Name
Last Name
Gender
*
Male
Female
Other
Ethnicity
*
Māori
NZ European
Pacific Islander
Other
Please specify your ethnicity
Please list any Iwi or Hapu Affliation(s) you have here
Age
Date of Birth
*
-
Day
-
Month
Year
Date
Training, Education and Employment
What is the highest qualification you have achieved?
*
No qualification
NCEA Level 1
NCEA Level 2
NCEA Level 3
Level 4 to 6 Qualification
Level 7 Qualification or Higher
Have you ever experienced expulsions or stand-downs from school, or been asked to leave school?
*
Yes
No
Are you currently in some form or employment, education, and/or training?
*
Yes
No
In the past 12 months, how many months have you NOT been in employment, education or training?
*
0
1
2
3
4
5
6
7
8
9
10
11
12
Are you currently receiving any type of WINZ support / MSD benefit?
*
Yes
No
Current Drivers Licence
*
No Drivers Licence
Learners Licence
Restricted Licence
Full Licence
Do you have children/ dependants?
*
Yes
No
Do you have any criminal convictions?
*
Yes
No
How old were you when you last attended school?
*
Did you become unemployed, or leave school or training because of COVID-19?
*
Yes
No
Contact Information
Address
*
Unit/Street Number
Street/Road Name
Suburb
City
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
The programme will be held at the Commuity Hub at 15 Earl Richardson Ave in Wiri, will you have transport to get to the programme?
Yes
No
Not sure yet
Email
example@example.com
Emergency, Medical & Consent
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Do you have any medical conditions?
*
Yes
No
Please advise what your medical condition is AND if you take regular medication for it
Do you need support with taking your regular medication? For example, assistance to take a inhaler?
Yes
No
Are there any other health concerns you may have that we need to be aware of?
*
Get Ready Work Ready Registration
Get Ready Work Ready is funded by the Ministry of Social Development (MSD). As part of our funding agreement, we are required to provide demographic data of participants in this programme to MSD. This data is used for monitoring and research purposes. I understand that this information will not be shared to third parties.
I consent to the above information being used for the purposes stated above
*
Yes
No
Submit
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