Application for Employment

Position Applied For *

Preferred Title *

Surname / Family Name *

Daytime Phone Number *

Mobile Phone Number *

Email Address * (you will be emailed a copy of your application)

Are you legally entitled to work in New Zealand? *

Date of Birth (optional)

Do you hold a current drivers licence? *

If Yes, which classes of licence?

If Yes, what is your Drivers Licence Number?

Are you awaiting hearing of any charges for driving offences? *

Have you ever been dismissed or asked to resign from a job? *

If your application is accepted, when could you start work? *

Have you ever been convicted of a criminal offence or are you awaiting charges in a criminal court of law? *

If Yes, please give details (This does not include convictions that are subject to the clean slate scheme of the Criminal Records (Clean Slate) Act 2004).

Do you suffer from an illness/disability/medical condition which would be aggravated or made worse by performing the job you have applied for? *

Are you on any medication which would affect your performance in the job you have applied for? *

Are you prepared to abide by Council's Health and Safety Regulations? *

Do you agree to take part in any identified health monitoring that are applicable to your position and work activities? *

How many days have you been absent from work in the last 12 months of employment as a result of sickness/injury? *

Tasman District Council's recruitment process requires you to supply a current Curriculum Vitae (CV) for each vacancy that you apply for.

You may also provide a cover letter detailing why you are applying for the position and an overview of the skills and experience you have which specifically meet the requirements of the position.

You will need to give details of at least 2 referees whose consent has been obtained and who may be contacted for a confidential reference. *

CV includes at least 2 Referees.

How did you find out about this vacancy (tick all appropriate)

Please read and acknowledge the Declaration below:

Conditions of Engagement

I give permission for the referees listed above to be contacted on my behalf in support of this application.

I give permission for my drivers licence to be verified by Land Transport Safety Authority or their agent.

I agree to abide by all Council policies, protocols, regulations and safety rules.

I confirm that I am a New Zealand citizen or hold a valid work visa and am legally entitled to work in New Zealand.

The applicant must, if called upon to do so, submit to a medical examination by a General Practitioner and the result of such an examination must be acceptable to the Council.

All inventions, patent rights or other processes developed or created by the employee in Council time during the period of employment by the Council shall be the sole property of the Council.

The applicant shall disclose to the Employer any injuries and/or illnesses previously suffered that may affect their ability to effectively carry out the duties for which they are being employed.

The offer of employment is based on information provided by the applicant in their application form, resume, employee health questionnaire and formal job interview(s). If any false or misleading information is given or any material facts suppressed, may result in termination of employment for serious misconduct.

Privacy Act Statement

The employee acknowledges that the Tasman District Council, 189 Queen Street, Richmond, collects the personal information concerning the employee for employment, disciplinary, statistical, insurance, taxation, health, safety and reference purposes and that the Tasman District Council may, from time to time, and under the provisions of the Privacy Act 1993, provide such personal information concerning the employee to others who require such information for similar or related purposes.

The information you provide on this application for employment form will be collected and held by the Human Resources Manager. This information is collected for the purpose of assessing your suitability for employment which may include subsequent changes in employment. We are unable to hold your application and CV "longer than is required for the purposes for which the information may lawfully be used" and, therefore, if you are unsuccessful in gaining this position, your CV will be returned to you and other information will be destroyed within three days of an appointment being made.

The employee may access personal information concerning himself / herself and may request corrections of that information pursuant to the Privacy Act 1993.

To the best of my knowledge, the answers to the questions in this application are correct, and I understand that if any false information is given or any material fact suppressed on this application form or on any health information forms, I may not be accepted, or if I am employed, I may be dismissed.

Should you be shortlisted for interview you will be required to sign a copy of this declaration as part of this process.

Ticking the box below indicates your agreement to the above Declaration.

I agree

Your friend's email address:

Personal Details

Criminal

Medical

Supporting Documentation

Declaration

Conditions of Engagement

Privacy Act Statement

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