CASUAL STAFF - APPLICATION FOR EMPLOYMENT
Attached is an application for employment form which you are requested to personally complete.

The Application Form is a source of information which will be used by the Company to assist it in considering your suitability to the position for which you are applying. If successful, such information shall form part of the Company's personal records. Failure to supply the information would prejudice the Company's ability to access your suitability for the position.

The Company undertakes to destroy the information collected relating to all unsuccessful candidates.

The above information is provided in accordance with the Privacy Act 1993.

CONFIDENTIAL
To be completed personally by Applicant Date of Application  
Note: The completion of this form does not indicate that there is any obligation on this operation to engage the applicant.

PURPOSE - This information is collected for the purpose of assessing your suitability for employment, which may include subsequent changes in employment with the Company.
POSITION
Position Applied For:
YOUR NAME
Surname:
Given Names:
Are you known by any other names?
YOUR HOME ADDRESS
Number and Street:
Suburb and Town:
TELEPHONE NUMBERS
Home Phone:
Work Phone:
Cell Phone:
Email Address:
AGE
Are you over eighteen years of age?
WORK
Are you legally entitled to work in New Zealand?
QUALIFICATIONS
School Qualifications (school certificate, university entrance etc) (subjects):
Do you have any other qualifications/ certificates/ licences or attended any course (give details):
Can you speak any language other than English?
Do you have apprenticeship papers?
In what trade were you apprenticed?
What was the name and address of the employer?
What trade qualifications do you hold?
EMPLOYMENT HISTORY
Present or Most Recent Employer
Work period From/To:
Company:
Address:
Position Held:
Main Duties:
No/ of hours worked per week:
Reason for leaving:
For the purposes of compliance with the Privacy Act 1993 do you consent to the Company contacting your present employer for the purposes of reference checking.
Next Most Recent Employer
Work period From/To:
Company:
Address:
Position Held:
Main Duties:
Number of hours worked per week:
Reason for leaving:
Next Most Recent Employer
Work period From/To:
Company:
Address:
Position Held:
Main Duties:
Number of hours worked per week:
Reason for leaving:
Have you ever worked for this business before?
If yes, when and where:
Do you have secondary employment?
If yes, when and where:
REFEREES
Give name, address and telephone numbers of at least two referees. (Preferably from where you have worked)
Referee One
Name:
Position:
Address:
Phone Number:
Referee Two
Name:
Position:
Address:
Phone Number:
Referee Three
Name:
Position:
Address:
Phone Number:
If your application is accepted when could you commence employment?
I consent to the company seeking verbal or written information on a confidential basis about me from representives of my previous employers and/or referees and authorise the information sought to be released by them to the company for the purposes of ascertaining my suitability for the position I am applying for. I understand that the information received by the company is supplied in confidence as evaluative material and will not be disclosed to me.
I agree?
GENERAL
Are you prepared to work shifts if required?
Have you worked shifts before?
Are you awaiting the hearing of charges in a civil or criminal court of law?
Are you prepared to handle all products, materials or equipment used in the industry?
Do you have a current drivers licence?
If yes - what class?
Do you have any demerit points or endorsements?
If yes, please detail
Do you have any relatives or known person currently employed by this business?
If yes, who?
What is the relationship with them?
Are you a member of any clubs, organisations, or the like which might have relevance to the position you have applied for? (detail please)
Are you at present receiving medical treatment and/or medication?
If yes, please detail
Are you allergic to, or have any sensitivity to any substances or chemicals?
Do you have any impairment, physical or mental, that would interfer with your ability to perform the job for which you have applied?
If there are any positions or types of positions for which you should not be considered or job duties you cannot perform because of a disability, please explain.
Do you consent to the Company retaining the information contained in this application form for the purposes of considering your suitability for any other position which may arise with this business in the future?