Employment Application Form

CURRENT QUALIFCATIONS

Rows	Qualification Title	Institution / Training Provider	Year completed
1
2
3

Please describe the skills you hold which are relevant to the position applied for (eg. for a typist - typing speed, word process capability, shorthand capability, etc):
CONVICTIONS / DISQUALIFICATIONS
To ensure the safety of clients / members you will also be required to undergo a criminal history check through the Department of Courts as part of the recruitment process. A criminal record will not necessarily be a bar to obtaining a position at the Kahungunu Executive. If a check is returned and reveals any information, this will be discussed with the applicant. The Team Co-ordinator, General Manager and Board of Management will make a decision as to whether the Offer of Employment should be withdrawn.
YesNo
If yes, please give brief details:
YesNo
If yes, please give brief details:

REFEREES
Please give the details for three references.
YesNo
Reference checks will be conducted legally in an ethical manner and all information derived will remain confidential.
Name of Referee One and relationship to you:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Post Code:
Telephone:
Format: (000) 000-0000.
Daytime:
Format: (000) 000-0000.
Mobile:
Format: (000) 000-0000.
Email address:
example@example.com
Name of Referee Two and relationship to you:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Post Code:
Telephone:
Format: (000) 000-0000.
Daytime:
Format: (000) 000-0000.
Mobile:
Format: (000) 000-0000.
Email address:
example@example.com
Name of Referee Three and relationship to you:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Post Code:
Telephone:
Format: (000) 000-0000.
Daytime:
Format: (000) 000-0000.
Mobile:
Format: (000) 000-0000.
Email address:
example@example.com

DECLARATION
- I declare that, to the best of my knowledge, the information given is true and correct.
- I understand that inaccurate, misleading or untrue statements or knowingly withheld information may result in termination of employment with this organisation.
- I understand that this application does not constitute an offer of employment.
- I understand that, in some cases, police and credit checks will be required and I will be notified if this applies to this application.
Signature
Date:

MonthDayYear
Date
EMPLOYMENT APPLICATION CHECKLIST
YesNo
Covering Letter

Cancelof
YesNo
CV

Cancelof
YesNo
When the deadline ends, all applications will be sent to KE. Our Business Services team will reach out acknowledging the applicanting and inform you of the process moving forward.

Best of luck.

Kahungunu Executive, 65 Queen Street, PO Box 79, WAIROA 4160
Telephone: (06) 838 6835 Fax: (06) 838 7290 E-mail: admin@kahu-exec.co.nz
Should be Empty:

REFEREES