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Job Application
Title: (please select one)
Mr
Mrs
Ms
Miss
First Name:
Last Name:
Preferred Name:
Address:
Home #:
Mobile #:
Email Address:
In the event of an emergency please contact
Name:
Contact Phone Number:
What language(s) do you speak?
Do you have reliable transport
Yes
No
Do you hold an NZ Driver’s License
Yes
No
License Type: please select which one
Full
Restricted
Learners
Class: please select which one(s)
1
2
3
4
5
Category:
T
W
R
Do you hold a Forklift License? If yes is it current?
Yes
No
Do you have F endorsement?
Yes
No
Do you require on-site accommodation? (limited spaces available)
Yes
No
Role interested in: (please circle which one)
Maintenance
Picking & Packing
Harvest Operator
Harvest Supervisor
Other
Please specify
Employment Details: (if details are provided on CV, section is not required to be completed)
Company Name
Position held & Duties
Duration
Salary/hourly Rate
Reasons for Leaving
Education / Qualification / Training
Name of school/college or training provider
Study Duration
Certificate/Qualification Obtained
Referees (Providing referee information below you are consenting to us making contact with them for a confidential assessment of your suitability to a position)
Name:
Company Name:
Relationship to you:
Phone Number:
Email Address:
Name:
Company Name:
Relationship to you:
Phone Number:
Email Address:
Can we contact your most recent employer?
Yes
No
Name:
Company Name:
Relationship to you:
Phone Number:
Email Address:
General Information:
• Are you legally entitled to work in New Zealand?
Yes
No
Please select one:
NZ Citizen
NZ Resident
Work Permit (provide proof & expiry date)
If a work visa, please indicate how long maximum you can work for one employer:
• Have you been convicted or charged with a criminal offence or have any pending charges?
Yes
No
Please provide more details:
• Have you ever been involved in a dispute with an employer and/or been subject to disciplinary action by an employer?
Yes
No
Please provide more details:
• Do you have any medical condition(s) or health issues, that may prevent you from being at work, may place yourself or others at risk, or prevent you from performing your duties in a safe manner at all times?
Yes
No
Please provide more details:
• Do you have any injuries to your back, neck, spine, arms or legs that may affect your ability to perform your duties?
Yes
No
Please provide more details:
• Have you ever suffered from Repetitive Strain Injury (RSI) or Occupational Overuse Syndrome (OOS)?
Yes
No
Please provide more details:
• Do you have any commitments that may prevent you from attending work in the future?
Yes
No
Please provide more details:
• If your application is accepted, when could you commence employment?
• If your application is for a fixed term period, how long are you available for?
• If you are successful do you agree that the employer can check your previous claims history with ACC?
Yes
No
(You will be required to complete a Pre-employment Check Form & provide ID).
• Do any of your family (including your partner or spouse) work for Kaipaki Berryfruits Ltd?
Yes
No
Please provide more details:
Hours & Days
If you are not flexible with your availability, please select days you are available to work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Do you have any planned holidays where you will need to take time off from work?
If yes, please detail:
Please upload the following forms
CV
Passport
Visa
Declaration
I declare that the information provided in this application is true, complete and correct. I understand that if I have provided false or misleading information that I may not be offered employment or, if employed I may be dismissed with immediate effect. I agree to notify Kaipaki Berryfruits Limited promptly with any supplied information changes. If I am employed this information will become part of my personnel file. If not employed this information will be held on file with Kaipaki Berryfruits Limited for a period of twelve months and then destroyed. In order for Kaipaki Berryfruits Limited to assess my ability to complete all duties within a given position, I understand, and consent to pre-employment screening which could involve any, or all, of the following; phone interview(s), face-to-face interview(s), medical check, credit check, drug and/or alcohol testing, referee checks, Ministry of Justice criminal check(s), on-site observations, group assessment(s) or psychometric testing.
Print Name:
Signature:
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Submit
Thank you for sending your details. We will contact as soon as posible.
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