Employment Application Form

Employment Application Form
This Employment Application forms part of Waiotahi Group of Companies employment files and must be completed and signed by the applicant. As part of the Walotahi Group of Companies commitment to a health and safe workplace we have a drug free workforce. A clean pre-employment drug test is required for all roles. We conduct pre-employment medicals for health monitoring purposes.
What Position/s are you applying for?
1. Tell us About Yourself
Full Name
Other Names you are known by
Address
What is your Home Phone Number?
What is your Mobile Number?
What is your Email Address?
example@example.com
Local Area or Region
Are you legally entitled to work in New Zealand?

NZ CitizenResidentWork VisaOther
Evidence of your eligibility to work in New Zealand might be required.
If your application is successful, when can you start?
Please attach a copy of your CV (if available)

Cancelof
2. What Licences do you hold?

Note: You will need to produce your Drivers License for inspection and record.
Select the applicable Licences:

123456DFRTW
Details of any other Licences held
License Number
Version
Expiry Date

DayMonthYear
Do you have any current demerit points?

YesNo
How many?
3. Tell us about your Education and Qualifications

Note: You will need to provide evidence of your qualifications.

	Qualification Title	Institute/Training Provider	Year Completed
1.
2.
3.
4.
5.
6.

Are you currently studying or planning to study for any Qualifications?

YesNo
If yes, please provide details.
Are you willing to undertake training during or outside business hours if requested?

YesNo
4. Previous Employment

Where else have you worked for? (Tell us about your most recent job first)

Type a question

	Commpany Name	I worked there from (When to when)	My job & main responsibilities were	I left because (reason for leaving)
1
2
3

5. Who can we contact to ask about you?

Please give us info on two people we can ask about you. A previous employer, manager, or team mate is preferred.
Contact 1
Name
Organisation
Position
Phone Number or email address
Contact 2
Name
Organisation
Position
Phone Number or Email Address
6. Have we met before?
Have you worked for Waiotahi Group of Companies before?

YesNo
If yes, what date did you start?

DayMonthYear
Finish Date

MonthDayYear
Position held
Branch
Why did you leave?
7. How's you health?
Waiotahi Group of Companies is concerned about the health and safety of its employees. We would like to know about any medical problems or any disabilities you have, in order to be able to give you the appropriate and prompt attention in the event of an emergency.
How would you describe your health?

ExcellentVery goodGoodAveragePoor
Do you presently have, or had in the past, any health problems that might affect your attendance and/or performance at work? If yes, please give us more details.

YesNo
Details of health problems
Have you ever had an injury that meant you had to take time off work? If yes, please give us more details.

YesNo
Details of Injury
Please, provide any other information that you identify as being relevant to this application (e.g. Medical conditions, disabilities).
8. Any Issues?
Have you ever been convicted of any criminal offence that is not currently excluded under the Criminal Records (Clean Slate) Act 2004? If yes, please give us more details.

YesNo
Details of criminal offence
9. General
Do you have any obligations which may interfere with your work attendance or performance? (Family commitments, community/ committee activities, sport). If yes, please give us more details.

YesNo
Details of obligations
Are you able to work Saturdays and Sundays if required?

YesNo
As a condition of employment, would you agree to your wages being paid by direct credit to your bank account?

YesNo
Are you available for work that involves staying away from your employment base?

YesNo
If your application is sucessful, you may also be required to work and carry out other duties on a temporary or permanent basis when requested.
10. Pre-Employment ACC History Check
As part of our hiring process, we require all candidates to complete an ACC Pre-employment check. This process will provide us with a report on any ACC claims you have previously had.

Please follow the link below to complete the check:

https://my.acc.co.nz/login?_ga=2.105200259.1030122210.1720666555-440407324.1720666513

When filling out the form, please ensure you enter the email address HR@waiotahi.co.nz in the box labeled 'Email the Employment Check to.'
11. Declaration
Please read the following statement carefully and then sign and put today's date if you agree to them.
- I state that, to the best of my knowledge, the answers supplied in the above application are true and correct.
- I accept that should my application be successful, the information I have supplied will form a part of my Contract of Employment and that any false information I have supplied is grounds for dismissal.
Your Signature

Clear
Date

DayMonthYear
Date
Should be Empty:

Employment Application Form

1. Tell us About Yourself

2. What Licences do you hold?

3. Tell us about your Education and Qualifications

4. Previous Employment

5. Who can we contact to ask about you?

6. Have we met before?

7. How's you health?

8. Any Issues?

9. General

10. Pre-Employment ACC History Check

11. Declaration