Employment Application Form

Personal Information:
Full Name*

First NameLast Name
Contact Address*

Street Address

Street Address Line 2

CityState / Prvince

Post CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
I identify my gender as
Birth Date*

DayMonthYear
Are You Legally entitled to work in New Zealand?*

YesNo
Are you legally entitled to work in New Zealand by way of a work visa ?*

YesNot applicable to me
Employment Desired:
Position Applying For*
Are you seeking*
Date You Can Start*

DayMonthYear
Date
Pay Expectations?*
Pay Rate Per Hour
How many hours per week would you like to work?*
Have You applied here before?*

YesNo
Have you been employed/ had a job before?*

YesNo
Are you prepared to work shifts if required to do so?*

YesNo
Have you ever been convicted of any criminal offence (except those cases where our asking you to declare them would breach the Criminal Records (Clean Slate) Act 2004?*

YesNo
Are you being investigated, or awaiting the hearing of charges in a civil or criminal court of law?*

YesNo
Are you prepared to handle all products, materials or equipment used in the industry?*

YesNo
Are you allergic to, or have any sensitivity to any substances or chemicals?*

YesNo
Do you have any physical or mental impairment, medication or medical treatment that would interfere with or affect your ability to perform the job for which you have applied?*

YesNo
If yes, please provide details*
If there are any positions, or types of positions, for which you should not be considered, or job duties you cannot perform, please detail and explain.*
Do you have any relatives or know any person currently employed by this business?*

YesNo
If yes, Who? and what is your relationship to them?*
Training and Skills:
What are you good at or enjoy doing?*
List any relevant skills
What Training or Qualifications do you have?*
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Reason for Leaving?
Start Date

MonthDayYear
Date
May We Contact?

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Previous Employer
Name of Previous Employer
Position
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reference:
Reference
Name of Reference
Relationship
Years Acquainted
Phone Number

Country CodeArea CodePhone Number
Email
example@example.com
Cover Letter

Cancelof
CV / Resume *

Cancelof
Do you consent to the business retaining the information contained in this application form for the purposes of considering your suitability for any other position which may arise with this business in the future?

YesNo
Do you agree that the business can seek verbal or written information on a confidential basis about you from representatives of your previous employers and/or referees and authorise the information sought to be released by them to the business for the purposes of ascertaining your suitability for the position you are applying for?

YesNo
Do you understand that the information received by the business is supplied in confidence as evaluative material and will not be disclosed to other parties?

YesNo
Send Application:
By clicking the submit button below, I declare that to the best of my knowledge the answers in this application form are correct and complete. I understand that if any false or misleading information, or any material fact is omitted, I will not be offered employment, or if I am employed, my employment could be cancelled or terminated.
Date

DayMonthYear
Date
Signature

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Current Employment:

Previous Employment:

Reference:

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