Windsor Architectural Hardware

General Details

Date

First Name

Last Name

Home Address

DAYTIME PHONE NUMBER

EVENING PHONE NUMBER

Mobile

Do you hold a current Drivers Liscence:

Yes

Qualifications and employment history

List of all formal qualifications you have achieved which are relevant to this position.

Qualifications

Length of Study (Give dates)

Relevant Papers/Subjects

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List of any relevant training that you have completed.

Course

Length of Study (Give dates)

Relevant Papers/Subjects

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Provide details of your present and previous employment. Please complete in full.

Name and address of Employer

From (Date) to (Date)

Postion and Main Duties

Reason for Leaving

May we contact this employer for reference?

Yes

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Have you ever been dismissed, or resigned as an alternative to being dismissed in previous employment?

Yes

If yes, please give details:

Legal Requirements

Are you entitled to work in NZ?

Yes

If yes, are you legally entitled to work because:

You are a NZ Citizen?

You have a Work Visa?

Other? (Please explain)

If other, please explain

If you have a work visa please attach a copy of this.

Attach Visa

Expiry Date of work Visa

Disabilites or Medical Conditions

Note: The Human Rights Act 1993 defines disability as: physical disability or impairment; physical illness; psychiatric illness; intellectual or psychological disability or impairment; the presence in the body of organisms capable of causing llness; any other loss or abnormality of a body or mind function; and reliance on a guide dog, wheelchair or other remedial means.

Do you have any disability or medical condition that may affect our ability to fully and effectively carry out the tasks and responsibilities described in job specification?

Yes

If yes, please provide details (please include any services or facilities which would allow you to carry out this role satisfactorily)

Do you have, or have you had, any injury or medical condition caused by a gradual process, disease or infection which may be aggravated by the function and responsibilities of the job for which you have applied, and it is describd in the attached job specification?

Yes

If yes, please provide details:

Do you have any present or past injury for which you may or may not have claimed acc and/or other insurance cover, which may be aggravated by the job you have applied for?

Yes

If yes, please provide details:

Have you suffered from any injury to your neck, shoulders or back?

Yes

If yes, please provide details:

Criminal History

I understand that any record of criminal convictions I might have will automatically be concealed if I meet the eligibily criteria stipulated in Section 7 of the Criminal Records (Clean State) Act 2004.

Have you ever been convicted of any criminal offence, including matters relating to dishonesty, E.G., fraud, theft, misappropriation of funds, within the last seven years?

Yes

Are you awaiting a hearing on any charges?

Yes

Declaration and acknowledgement

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Declarations

I declare that to the best of my knowledge the information that I have provided is accurate, and complete, and I have not withheid any information which may have a bearing or any relevance to my application.

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