APPLICATION FOR EMPLOYMENT
Please
complete this form and q return in
person q Mail to
Position
applied for:
Name
(Mrs/Miss/Ms/Mr):
Address:
Phone
(Home):
Date of birth
required if under 18 years of age
____/____/____ CV or other
information attached: qYes qNo
MOST
RECENT EMPLOYER
Name:
Address:
Phone: Contact person:
May enquiries
be made to your present employer? q Yes q No
EMPLOYMENT
HISTORY (start with most recent employer)
# of
Employer
Business From To
years Position held Reason for leaving
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Please list below any special attributes you
feel you would bring to this position?
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EDUCATION (include
tertiary education if applicable)
School Attended From
To No/Yrs Qualifications Attained
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MEDICAL
Have you had or suffer from? Yes
No When Details
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Back injury or strain? |
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Injury or strain to limbs? |
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Blackouts or fits? |
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RSI / OOS? |
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Previous work related injury? |
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Colour Blindness? |
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Hearing Impairment? |
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Contacts or Spectacles? |
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Are you dependant on drugs,
medications or alcohol? |
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Do you have any other
medical condition that could affect your performance in the position applied
for? |
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GENERAL
Do you have New Zealand
Citizenship? q Yes q No
If no, do you have permanent
residence? q Yes q No
If no, do you have a current
work permit? q Yes q No Expiry date
Do you have a current valid
drivers license? q Yes q No
Have you ever been convicted
of a criminal offence? q Yes q No Details
RECREATION,
HOBBIES, INTERESTS & COMMUNITY SERVICE
Please list below any recreational pursuits, hobbies or community services
you have been involved in:
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REFERENCES
Please
provide details of two other referees who are not related to you:
Name: Phone: How known:
Name: Phone: How known:
The information supplied above
and attached is a true and correct record. I hereby irrevocably authorize any
person or company to provide such information as you may require in response to
your employment enquiries. I also agree to this information being kept on file.
Signed Date