Application for Employment

Application for Employment

Position Applied for:
Date:
If your application is successful when could you start your new position?
Days/hours available to work: Part time
Full time
Shift work (including weekends and nights): Yes
No

Personal Details

Name:
Address:
Town:
Home Phone:
Mobile Phone:
Email:
Date of Birth:
Iwi Affiliation:

Education & Training

Please commence with secondary schooling.  Include all qualifications gained and courses attended.

 Qualification Gained

 School/Training Institute

 Date Completed

 

Employment Record

Please enter details of you previous five positions (or less if you have not worked for five employers in the past):

 Date of Employment Start

 Date of Employment End

 Employer

 Position

 Key Responsibilities

Referees

Please name two or three people who Miraka Limited can contact to gain information on you.

 Referee's name

 Relationship to you

 Contact phone number

     

Work Status

Are you legally entitled to work in New Zealand? Yes
No

Note:  You may be required to provide proof of eligibility to work in New Zealand.

General

 Do you hold a current New Zealand drivers licence? Yes
No
If YES, which classes:
Do you hold a current fork lift licence? Yes
No
Have you had any criminal convictions? Yes
No
If YES, please detail:

Medical

Have you had an injury or medical condition caused by gradual process, disease or infection, for example, hearing loss, sensitivity to chemicals, repetitive strain injuries that may be aggravated or further contributed to by the tasks for this job?
Yes
No
If YES, please detail:
Do you have any claim or compensation history with ACC?
Yes
No
If YES, please detail:
Are you aware of any known condition, serious injury or illness that may affect your ability to effectively carry out the functions and responsibilties of the position applied for?
Yes
No
If YES, please detail:
Do you agree to undergo a medical assessment if required; understanding that part of this medical assessment may include drug testing?
Yes
No

CV and Cover Letter

 CV Upload
Cover Letter Upload

 

Declaration

By submitting this form you declare that to the best of your knowledge, the answers in this application are correct and you understand that if any false or deliberately misleading information is given, or any material fact suppressed, you will not be accepted, or if you are employed, your employment may be affected.