Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
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NOTE: The completion of this form does not indicate that there is any obligation by Secure Guard Services Waikato Ltd to engage the applicant.
PURPOSE
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This information is collected for the purpose of assessing your suitability for employment on the date of this questionnaire, which may include subsequent changes in employment with Secure Guard Services Waikato Ltd. We wish to retain the information on file.
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Permission granted
PERSONAL DETAILS
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Name:
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Are you known by any other name?
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Give Details
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Home Phone Number
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Mobile Number
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Email
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Please state whether you are a New Zealand citizen, a permanent resident or have a current work permit.
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If applicable, when does your work permit expire?
EDUCATION
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Education Level Attained?
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Other Qualifications
LANGUAGES
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Can you speak any language(s) other than English?
QUALIFICATIONS
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Do you hold a current COA?
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NZQA Levels completed?
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Current First Aid certificate?
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If Yes, what is the expiry date?
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Please describe any other skills you hold which are relevant to the position.
EMPLOYMENT HISTORY
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Present or most recent employer. From/To
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Contact person details?
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Position held?
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Main duties?
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Number of hours worked per week?
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Required notice period?
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Reason for leaving?
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For the purposes of compliance with the Privacy Act 1993, do you consent to the company contacting your present employer for the purpose of reference checking.
EMPLOYMENT HISTORY
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Company. From/ To
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Contact person details?
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Position held?
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Main duties?
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Number of hours worked per week?
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Reason for leaving?
EMPLOYMENT HISTORY
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Company. To/From
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Contact person details?
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Position held?
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Main duties?
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Number of hours worked per week?
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Reason for leaving?
OTHER EMPLOYMENT
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Give details of any other previous job that may be relevant.
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Have you ever worked for this company before?
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If Yes, where and when?
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Do you have secondary employment/occupation?
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If Yes, where and when?
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Do you intend to work for any other security company at the same time?
REFEREES
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Name
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Company
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Address
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Phone number
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Name
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Company
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Address
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Phone number
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If your application is accepted, when could you commence employment?
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I consent to the company seeking verbal or written information about me from representatives of my previous employers and/or referees and authorize the information sought, to be released.
GENERAL
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Are you prepared to work overtime if required?
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Hours you prefer working....
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Days you prefer working....
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Do you have a criminal record? ( you should consider the effect of the Criminal Records ( Clean Slate) Act before answering this question. You can obtain free information on this from the Department of Labour 0800 209 020)
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Are you awaiting the hearing of charges in a criminal court of law?
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Do you consent to authorize a criminal record check?
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Do you have a current drivers licence?
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If yes, what class?
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Drivers licence number
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Do you have any demerit points or endorsements ?
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If Yes, please detail
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Do you consent to authorize the company to check the status of Current Drivers Licence?
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Any disqualifications within the last 2 years?
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Are you prepared to complete a pre employment drug test?
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Are you a member of any Territorial Force Unit?
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If yes, have you completed whole time training?
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What are your interests/hobbies/sports/clubs or community activities?
MEDICAL
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Do you smoke?
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Do you agree to undergo a medical examination if required?
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Are you allergic to, or have any sensitivities to any chemicals?
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Do you require corrective lenses or contact lenses?
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State any injury or condition you have suffered that may affect your ability to effectively carry out the functions and responsibilities of the position applied for:
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Do you have any other known condition, which may affect your ability to safely and effectively carry out the functions and responsibilities of the position applied for?
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If yes, please explain
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Have you ever had difficulties coping with change, or other stressful events in the workplace?
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If yes, please explain:
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Is there any other information you believe is relevant to your application?
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If yes, please explain:
TRIAL PERIOD ( if applicable )
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Are you prepared to consider a 90 Day Trial Period as detailed in the Companies Employment Agreement?
PROBATION PERIOD ( if applicable )
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Are you prepared to consider a 90 day Probation Period as detailed in the Companies Employment Agreement?
PRIVACY INFORMATION
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Do you consent to the Company retaining this form for the purposes of considering your suitability for any other position, which may arise with this Company in the future? If you are successful in this application, this form will form part of your employment file.
AGREEMENT TO DEMONSTRATE SKILLS
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I agree that if requested to demonstrate my skills during the course of this selection process, such request does not constitute a job offer or the commencement of employment. I may decline the request, but if I agree, I will not be entitled to payment.
DECLARATION
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I declare: 1. That my answers in this application are true and not misleading; and, 2. That there is no further information that may be relevant that I have not told you about.
I ACKNOWLEDGE
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1. That if you employ me, you are relying on the truth and completeness of my answers and therefore; 2. That if I have not answered truthfully and completely, the Employer may have justification to terminate my employment without notice.
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