Application for employment

Application for employment with CCS Disability Action
The purpose of this application is to assess your suitability for the position. This application form must be completed by the applicant accurately and truthfully. Failure to supply or disclose requested details may result in your application being withdrawn from consideration. If successful, this application form will become part of your personnel record with CCS Disability Action. Accordingly, all information on this form will be kept confidential. Please note: completing this form does not obligate CCS Disability Action to employ you.

About you
Name*

First NameLast Name
Preferred name
Gender (optional)
Date of birth (optional)

DayMonthYear
Current address*

Street address

Street address line 2

SuburbCity/region

Postcode
Phone number*

Area CodePhone Number
Email*
example@example.com
Ethnicity (optional)
Which option best describes your legal working rights to work in Aotearoa New Zealand?*

CitizenResidentWork visa
If you are on a visa, when does your current visa expire?*

DayMonthYear
Which of the below can you provide to confirm your working rights?*

NZ passportNZ birth certificateWork visa and overseas passport
Do you have lived experience of disability? (optional)

Your work history
Please upload your cover letter (optional - maximum size 10 MB):

Cancelof
Please attach your CV (maximum size 10 MB):*

You must ensure that your CV clearly includes your education history, qualifications and employment history - including by position the organisation name, position held, main duties, start and end date, reason for leaving.
Cancelof
Please upload any other relevant documents or certifications to support your application (optional - maximum size 10 MB):

Cancelof
Is there any other aspect of your employment experience that you think is particularly relevant to this position?
Do you have a current NZ First Aid Certificate?

YesNo
Have you ever been employed by CCS Disability Action? If yes, in what capacity and when?
If offered this position, will you have any other employment or voluntary engagements that could create a conflict of interest with CCS Disability Action?*
Do you have any friends or whānau members currently employed with CCS Disability Action?

YesNo
Do you consent to CCS Disability Action retaining your application information for six months to consider you for other positions?

YesNo

References
We use Xref for conducting pre-employment references. Please provide contact details for at least two referees, including one who can speak to your work and was a supervisor or senior in your most recent/current position. Reference will not be contacted without your consent.

Health and safety

The following information is required to assist CCS Disability Action in meeting our obligations under the Health and Safety at Work Act 2015 and the Accident Compensation Act 2001.
Do you have or have you had any injury or medical condition (e.g., repetitive strain, back injury, hearing loss, chemical sensitivity) that could be aggravated by the tasks of this job?*

YesNo
If yes, please provide details*
Could this condition affect your ability to perform this job?*

YesNo
If yes, please provide details*
Are there any reasonable accommodations, or specific support or equipment required?*

YesNo
If yes, please provide details*
Do you have any other health issues that could affect your ability to do this job?*

YesNo
If yes, please provide details*

Declaration
By submitting this application for employment with CCS Disability Action, you declare that:
- I consent to CCS Disability Action seeking confidential information from my nominated referees. I understand this information will be treated as evaluative material and will not be disclosed to me.
- I certify that all information provided by me, both orally and in writing, is true, complete, and correct to the best of my knowledge.
- I understand that providing false, incomplete, or misleading information, or omitting important details, may result in disqualification from the position or termination of employment if appointed.
Do you consent to all of the above?*

Yes
Would you like to receive a copy of this submission?*

YesNo
Should be Empty:

Application for employment with CCS Disability Action