Employee Detail Form

Employee Detail Form

Items marked with * are mandatory
GENERAL
Surname*
First Name*
Middle Name
Appropriate Title*
Employee Known as*
i.e name you prefer to be called if you different to above
Employee Home Phone no*
Employee Mobile Phone no*
Employee Address*
Post Code*
Date of Birth*

DayMonthYear
Date
Email Address*
Vehicle - Make, Model & Rego Number*
Bank Account & IRD
Bank Account Name*
Bank Account Number*
Bank*
Branch*
Employees IRD Number*
Employees Tax Code*
Kiwisaver Scheme
I am already enrolled in the KiwiSaver Scheme prior to coming to Molloy Agriculture Limited.*

YesNo
I wish to join the KiwiSaver Scheme.*

YesNo
If yes, I have attached a KiwiSaver Deduction form (KS2). I would like my contribution rate to be:*

3%4%8%10%
I do not wish to join the Kiwisaver Scheme and have attached KS10, the New Employee op-out request*

YesNo
Emergency Contact
Emergency Contact Name*
Relationship of Emergency contact to you i.e. Partner, Parent, Friend etc*
Home phone number
Mobile phone number*
Medical Information

(Please list any conditions that we should be aware of for your safety at work in the event of accident or illness, e.g. allergy to penicillin, Heart medication, diabetic etc)
Known allergies
Medication
Other Conditions
Doctor
Phone Number
Blood Group
Special Requirements
I advise that the information provided in this document is accurate.
Signed*

Clear
Dated*

MonthDayYear
Date
Molloy Agriculture Limited advises and confirms the information contained in this Employee Detail Form sections 4 and 5 herein will be retained in confidential staff records for use by the Company only in the event of medical or other emergency.

All information supplied will be held and utilized pursuant to the requirements of The Privacy Act 1993.
Should be Empty:

Employee Detail Form

GENERAL

Bank Account & IRD

Kiwisaver Scheme

Emergency Contact

Medical Information