(All fields are required)
1. Advertising Avenue:
Where did you see this role advertised?
2. Legal work status:
Are you legally entitled to work in NZ in this job
3. Health and Safety:
Please confirm that you do not take any illicit drugs and that your system is free from the effects of drugs and alcohol
4. Driverâs Licence:
Please describe your driver license status
5. Declaration of injury/or pre-existing condition that may affect you in this role.:
Do you suffer from any illness, injury or other disability which may adversely affect your work performance, regular attendance at work, personal safety of yourself or others?
6. Declaration of injury/or pre-existing condition that may affect you in this role.:
If you have answered Yes to the above question, provide details.
7. Declaration of injury/or pre-existing condition that may affect you in this role.:
Should your application be successful, would you agree to attend a Registered Health Professional nominated by the South Taranaki District Council as and when required and also undergo a drug and alcohol pre-employment test?
8. Court Convictions:
Have you ever been convicted in a court in New Zealand or any other country?
9. Court Convictions:
Are there any charges against you yet to be heard?
10. Court Convictions:
If you have answered Yes to either of the previous two questions, please provide brief details:
Have you entered into bankruptcy or any material accommodation with creditors?
If you have answered Yes to the above questions, please give details.
Are there any other issues, such as disciplinary or dismissal matters, which you should declare to us in order for us to be fully informed when making the selection decision.
If you answered yes or unsure above, please describe the detail for us.
15. Work Referees:
Please nominate two people able to comment on your ability to perform the duties of the position applied for. These must be previous Supervisors or Managers(Please provide: Name, Address, Phone and Relationship to applicant).
16. Work Referees:
Can the above referees be contacted for reference checking purposes and be authorised to disclose such information that may be required.
I declare that the information provided in this application and CV, is correct. I understand that falsification; deliberately misleading; or, suppression of information, will be grounds for instant dismissal.