Employment Application Form (JK)

Application for Employment

Please fill in the form below.
Confidential    This application is to be completed personally by the applicant.

Note;                The completion of this form does not indicate any obligation on the company to employ the applicant.

Purpose;           This information is collected for the purpose of assessing your suitability for employment with Success Personnel Ltd, as a casual employee for any assignments that may be offered.
Date Applied*

DayMonthYear
Position applied for
Full Name*

Mr./Mrs./Miss.First NameLast Name
Are you known by any other name?*
If yes, what is your other name?
Date of Birth

DayMonthYear
Note: New Zealand address only

For applicants outside of New Zealand, please email Graham Rodgers at graham@successhr.co.nz
Address*

Street Address

Street Address Line 2

CitySuburb

Post Code
Phone Number

Area CodePhone Number
Mobile Number
Are you a Kiwisaver member? *
Pay Slips are emailed weekly – Email address: *
IRD Number
Bank Account Number
note: some bank accounts requires 3 digits for their suffix
Emergency contact details
Name*
Relationship*
Contact Number*
Are you legally entitled to work in New Zealand? *
Can you hold an everyday conversation in English? *
Can you hold an everyday conversation in any other language *
If yes, please give details
Have you reached to current school leaving age? *
Qualifications and experience
Do you have New Zealand Driver's Licence?*
Are you applying for a Labour, Trades, Drivers, or Roading Construction Roles*
What current drivers licences do you hold? *

1 Car up to 45002 Heavy Traffic up to 18000kg2 L (Heavy Traffic up to 18000kg)3 Trailer for (2)4 Heavy Traffic over 18000kg4 L (Heavy Traffic over 18000kg )5 Trailer for (4)6 MotorcycleD Dangerous GoodsF ForkliftR RollerT TracksW WheelsP PassengerNone
Any other classification including Current Forklift Certificate
Do you have a current OSH forklift Certificate?*
Expiry Date

DayMonthYear
Drivers Licence and version number
Do you have any demerit points
Vehicles, Trucks, or Machinery you had experience with
Do you have your own transport*
If “No”, then how would you get to work?
Do you have your own steel capped work boots*
Are your steel cap boots*
Interests (Hobbies, Sports, Voluntary Work)
Do you have a Site Safe Passport?*
Site Safe Expiry Date

DayMonthYear
Do you have a ConstructSafe Card?*
If Yes, when was it taken?

DayMonthYear
Education Qualifications
Tertiary Qualifications
Trade Qualifications
Upload Trade Certificates here

Upload a File

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Other Qualifications
Employment History (Please begin with your most recent employer)
Employer
Phone Number

Area CodePhone Number
Job Description/Duties
Period of Employment
From

DayMonthYear
To

DayMonthYear
Reference contact
Name
Title
Phone Number

Area CodePhone Number
Employment History
Employer
Phone Number
Job Description/Duties
Period of Employment
From

DayMonthYear
To

DayMonthYear
Reference contact
Name
Title
Phone Number

Area CodePhone Number
Need More Employment History Form?

YesNo
Employment History
Employer
Phone Number

Area CodePhone Number
Job Description/Duties
Period of Employment
From

DayMonthYear
To

DayMonthYear
Reference contact
Name
Title
Phone Number
Medical
ACC History. Have you ever had an injury resulting in time off work *
If yes, please give details
Do you have any health related issues (including stress) that may impact on your ability to perform any tasks that you may be asked to perform? These may include but are not limited to lifting, digging, working at heights, in enclosed spaces, with chemicals and solvents, operating machinery and power tools. Some of these issues may include. *

DermatitisFoot troubleBack StrainBack InjuryVaricose VeinsMigrainesSight ProblemsAllergiesHerniaDiabetesHearing ProblemsAsthmaNone
Other medical conditions
Do you consent to a drug test should it be part of the Health and Safety policy of the company you are on assignment with.*
General
Have you worked for this, or any other labour hire company in the past? *
If yes, when and where?
Do you have any secondary employment.*
If yes, please give details
Do you have any criminal convictions that are not covered by the Clean Slate Act?*
Please note that previous convictions will not exclude you from being invited to an interview.
If yes, give details
Are you awaiting the hearing of any criminal charges or civil legal proceedings*
Have you ever brought a personal grievance against a previous employer *
Are you available for *
When could you start work? *

DayMonthYear
Hourly expected rate
Are you prepared to comply with confidentiality policies. *
Type of work wanted
Type of work NOT wanted
Comments
Upload CV here

Upload a File

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How did you hear about us?*
Others, please specifiy
Should be Empty:

Application for Employment

Note: New Zealand address only