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Application for Employment Form

Please complete this Application for Employment yourself. It is desirable that you also attach your current Curriculum Vitae to the form along with any other relevant documents that you believe would support your application. Please do not include any original documents.

This application form is a source of information which will be used to assist us in considering your suitability for the position for which you are applying. Thank you for taking time to complete the form.

Position Details
Position Applied For
Personal Details
Surname
First Names
Gender
Male Female
Are you known by another name? YES NO
If yes what other names are you known by?
Surname
First Names
Address
Postal Address (If different)
Home Phone Number
Work Phone Number
Mobile Phone Number
Other
Email Address
Date of Birth
Curriculum Vitae
Upload your CV
Legal Work Status
Are you a New Zealand Citizen? YES NO
If yes, can you produce evidence if required? YES NO
If no, do you have the right of permanent residence or a work permit? YES NO
(It will be necessary to produce your passport and associated documentation for verification)
If you hold a work permit, what is the expiry date?
Education/Qualifications
School/Polytechnic/University/Apprenticeship/Other (Years) Qualifications
Languages
Do you speak any language other than English? YES NO
If yes, which language(s)?

Specific Reasons for Applying for this Position

Employment History
Current or most recent employment:
Organisation/Location
Position Title
From

To

Key Position Accountabilities (include any relevant job dimensions - e.g. staff and budget managed)

Key Achievements in Position

Reasons for Leaving (where applicable)

Next Most Recent Employment
Organisation/Location
Position Title
From

To

Key Position Accountabilities (include any relevant job dimensions - e.g. staff and budget managed)

Key Achievements in Position

Reasons for Leaving (where applicable)

Next Most Recent Employment
Organisation/Location
Position Title
From

To

Key Position Accountabilities (include any relevant job dimensions - e.g. staff and budget managed)

Key Achievements in Position

Reasons for Leaving (where applicable)

Medical

Please declare any current health or physical matters and/or impairments which may be aggrivated or prevent your ability to carry out tasks in this position (e.g. back, hearing, eyesight or heart problems, or any physical injury)

Have you had an injury or medical condition caused by a gradual process (e.g. hearing loss, sensitivity to chemicals, repetitive strain injuries, etc) which may be aggrivated, or may prevent your ability to carry out taks in this position?)

YES NO

If yes, please detail

Do you agree to undergo a full medical examination (including a test for class A, B or C drugs) if required?

YES NO

Do you have any allergies/intolerances that we should be aware of? (e.g. peanuts, other nuts, food allergies, etc.)

YES NO

Are you a smoker?

YES NO

Have you had any previous injury or medical history in the last 10 years?

YES NO

Do you wear contact lenses?

YES NO

General Questions
Have you ever been convicted, diverted or convicted and discharged in relation to any criminal offenses?

YES NO

Are you awaiting the hearing of charges in a civil or criminal court of law?

YES NO

Do you agree to police disclosure being sought?

YES NO

Have you had a formal warning from a previous employer?

YES NO

Have you ever been dismissed from previous employment?

YES NO

Have you ever been made redundant from previous employment?

YES NO

Do you have a spouse, partner, relative or household member working here or elsewhere in the industry?

YES NO

If yes, who?
Do you have a current New Zealand driver's license?

YES NO

If yes, number:

Learner

Restricted

Full

Classes Held
Any demerit points?

YES NO

Has your license ever been endorsed?

YES NO

If yes, give brief details.
What transport arrangements do you have to get to and from work?
If you intend to drive yourself to work, what is the registration, make and model of your vehicle?
Are you a member of any territorial force unit?

YES NO

If so, have you completed the whole time training?

YES NO

Do you consent to the Company retaining the information contained in your application for the purposes of considering your suitability for any other position that may arise in the future?

YES NO

Referees

Please provide the names and contact phone numbers (daytime, and if possible, after hours) of at least four (4) recent work related referees, where there has been a direct relationship: (i.e. managers that you have reported to, colleagues that you have worked with and the staff you have managed).

Name Relationship Contact Phone Numbers
(day and after hours)

I consent to Prolife Foods Limited to seek verbal or written information on a confidential basis about me from the above referees, and I authorise these referees to release information to Prolife Foods Limited for the purposes of ascertaining my suitability for this position.

Signed Date

DECLARATION:

I (full name) declare that, to the best of my knowledge, the details given in this application form are accurate and correct and I understand that if any false or deliberately misleading information is given, or any material fact suppressed, my application will not be accepted, or if I am employed, my employment will be terminated.

Signed Date

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