Application Form

Type of Position(s)Full TimePart TimeTemporaryContract

First Names*

Surname*

Address

Phone: Business

Phone: Private

Phone: Mobile/Alternative

E-mail Address*

Date of birth*

Current NZ Drivers LicenceYesNo

Other Licences

Qualifications

Preferred fields of Employment

Additional Skills

Have you ever had a work related injury? e.g.

RSI/OOSYesNo

Hearing lossYesNo

Eye lossYesNo

Back injuryYesNo

Or any other, please explain

Are you allergic to, or have any sensitivity to any substance or chemicals?

YesNo
If yes, please explain

Has your work ever been affected by stress or mental health problems
(e.g., depression, anxiety)?

YesNo
If yes, please explain

Have you ever suffered from long-standing fatigue or tiredness?

YesNo
If yes, please explain

Additional Comments

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is held.

I (Full Name) confirm that the above information is correct.