Pukatono Tūranga | Application for Intern Board Member

Pukatono Tūranga | Application for Intern Board Member

To be completed personally by the applicant
Kia tupato | Note: Mena e whakakī i tēnei puka kahore e tohu ana he herenga anō mo Sport Northland kia uru atu ki te kaitono | The completion of this form does not indicate that there is any obligation of Sport Northland to engage the applicant.

Kaupapa | Purpose: I koha ēnei kōrero mō te aromatawai i tō ake tika ki Sport Northland, ka uru pea ki ngā whakarerekētanga mahi ki Sport Northland | This information is collected for the purpose of assessing your suitability for the board of Sport Northland.
Tono mo te tūranga | Position applied for:*
Mōu | About You
Ingoa | Given names (on birth certificate):*
Whānau Ingoa | Family name:*
Iwi
Hapū
Marae
Ō Pārongo Whakapā | Contact Details
Wāhi noho | Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Īmera | Email*
example@example.com
Nama waea | Phone Number (Home)
Please enter a valid phone number.
Waea pūkoro |Phone Number (Mobile)*
Please enter a valid phone number.
Te Mana Mahi Ture | Legal Work Status
E āhei ana koe ki te mahi ki Aotearoa? | Are you legally entitled to work in Aotearoa New Zealand?*
Reo | Languages

E kōrero ana i te reo Māori? Can you speak Te Reo Māori?

	Tick the level that applies to you:
Kākano/Beginner
Rito/Intermediate
Matatau/Fluent

E kōrero ana i ngā reo o te ao? | Can you speak any language other than Te Reo Māori and English? (if yes, please give details)
Pūkenga | Skills
Tēnā, whakamohio mai ōu ake pūkenga e hangai ana ki tēnei tūmomo mahi | Please describe the skills you hold which are relevant to a governance board
Mahi Hītori | Employment History
Present or most recent employer:
Pakihi | Organisation:
Tūranga | Job Title:
Mahi matua | Main Duties:
Hāora mahi | Number of hours worked per week:
Wā mahi | Length of service:
Mō te mahi tōtika mātou i te 'Privacy Act 1993' e āhei ana mātou ki te kōrero ki tō wāhi mahi me tō kaituku mahi hoki? | For the purposes of compliance with the Privacy Act 1993, do you consent to Sport Northland contacting your present employer for the purposes of reference checking?

Āe/YesKahore/No
Wheako | Other relevant experience:
Tuhia nga taipitopito mō ētahi atu wheako e whai kiko ana | Please give details of any other experiences which may be relevant:
Kua mahi ano koe mo Sport Northland e hono atu ana i mua? | Have you ever worked or volunteered for Sport Northland or an associated Regional Sports Trust before?

Āe/YesKahore/No
Kōrero mai | If yes, when?
Rewherī | Referees

Please provide the details of at least two referees.
Ingoa | Name

First NameLast Name
Ingoa pakihi | Organisation
Tūranga | Position
Nama Waea | Phone Number
Please enter a valid phone number.
Īmera | Email
Ingoa | Name

First NameLast Name
Tūranga | Position
Nama Waea | Phone Number
Please enter a valid phone number.
Īmera | Email
Ka whakaae ahau ki Sport Northland ki te rapu kōrero, kōrero tuhi ranei mo au mai i nga mangai o aku rangatira o mua me nga kaitautoko rānei ki te whakamana i nga korero i rapuhia kia tukuna atu ratou ki Sport Northland mo nga take kia kitea ai taku pai mo te wāhi ka tono ahau. Kei te marama ahau ko nga korero i tae mai ki a Sport Northland he mea whakawhirinaki hei rauemi arotake, kaore hoki e whakaaturia mai ki ahau.

I First NameLast Name consent to Sport Northland seeking verbal or written information on a confidential basis about me from representatives of my previous employers and/or referees and authorise the information sought to be released by them to Sport Northland for the purposes of ascertaining my suitability for the position for which I am applying. I understand that the information received by Sport Northland is supplied in confidence as evaluative material and will not be disclosed to me.

SignatureDate
Ngā Pātai Whānui | General
Are you available to attend monthly board meetings after hours from 5.30-8pm?*

Āe/YesKahore/No
E tātari tonu ana koe mō ētahi whakapae taihara? | Are you awaiting the hearing, determination or sentence on any criminal charges?*

Āe/YesKahore/No
Kei a koe ētahi ongā hara taihara o mua? Atu i ngā mea i huna nā te 'Criminal Records (Clean Slate) Act 2004' | Do you have any previous convictions excluding those concealed by the Criminal Records (Clean Slate) Act 2004?*

Āe/YesKahore/No
Kei a koe ētahi atu mea i te aroaro te kōti kahore he mea taihara e tātari tonu ana kia whakarongo, kia whakatau kia tukana atu rānei? | Do you have any other matters before the court not criminal in nature awaiting hearing, determination or disposal?*

Āe/YesKahore/No
Kua whakapeau e koe mai i te kōti? | Have you been the subject of a diversion ordered by the Courts?*

Āe/YesKahore/No
E whakāe ana koe ki te tirotiro i ngā pirihimana me te kōrero e tohatohaina ana ki a Sport Northland? | Do you agree to undergo a Department of Courts / Police screening check and the information being released to Sport Northland?*

Āe/YesKahore/No
Kei a koe he hoa rangatira, whanaunga i Sport Northland me tenei momo mahi? | Do you have a spouse, partner, relative or household member working at Sport Northland or elsewhere in the industry?*

Āe/YesKahore/No
Kōrero mai | If yes, who? and where?
He aha ngā mea e pai ana ki a koe, ngā mea whakangahau ngā hākinakina, ngā karapu me ngā mahi a te hapori? | What are your interests/hobbies/sports/clubs or community activities?*
Cover Letter and CV
Upload your Cover Letter here:

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Upload your CV here:

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Whakapuakitanga | Declaration
I, First NameLast Name declare that;

Mōku ake, ko ngā korero o tēnei puka me ngā mea e piri ana he pono;Kei te mārama ahau mena he kōrero rūkahu, kōrero huna rānei kahore ahau e mahi mena ka tukuna ki ahau ka whakaoti koutou taku mahi;Ko ngā kōrero toka e pa ana ki taku hitori hauora ka ngaro pea taku mana mō tētahi tautoko mai i a ACC. (Kei te mārama ahau ko ngā tono mahi mena ka tukuna ahau ko ngā tono, mahi mena ka tukuna he here ki te whiwhi taku whakawhiwhinga hauora).

To the best of my knowledge the information provided in this application and in any resume enclosed is accurate. I understand that if any false or misleading information is given, or any material fact suppressed, I will not be employed, or if I am employed, my employment will be terminated. Any false information given in relation to my medical history may result in my loss of entitlement for any compensation from Sport Northland’s contracted accident insurance provider and/or ACC. (I further understand that any offer of employment if made is conditional on my obtaining a full medical clearance through the Company’s pre-employment medical).

SignatureDate
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Pukatono Tūranga | Application for Intern Board Member

Mōu | About You

Ō Pārongo Whakapā | Contact Details

Te Mana Mahi Ture | Legal Work Status

Reo | Languages

Pūkenga | Skills

Mahi Hītori | Employment History

Present or most recent employer:

Wheako | Other relevant experience:

Rewherī | Referees

Ngā Pātai Whānui | General

Cover Letter and CV

Whakapuakitanga | Declaration