Registration - Advanced Personnel

Name*

Prefix First Last

Known as / Nickname:*

Date of Birth*

Choose desired category of employment (1)*

Choose desired category of employment (2)*

Job Number

If you are registering for a specific advertised position, please enter the job number here.

Consultant

If you are already dealing with one of our Consultants, please choose that person here.

Address*

Street Address City Box/Suburb Post Code Country

Road, Street etc

Bussiness Phone

eg. 03 365 4322

Fax

eg. 03 365 4322

Home

eg. 03 365 4322

Cell

eg. 03 365 4322

Email

Other Contact

Citizenship

Citizenship*

New Zealand or Australian Citizen
Permanent NZ Resident
Hold NZ Work Permit
Require NZ Work Permit

How did you first hear about us?*

If not NZ Citizen or Resident

Nationality

Passport Issuing Country (or Country of Birth)

Passport No.

Work Permit No.

Expires

Date of arrival in NZ (if overseas)

Work Sought

Temporary/Contract

Y
N

Full Time

Y
N

Part Time

Y
N

Have you Temped before?

Y
N

Available to start

For How Long?

Temporary/Contract

Y
N

Full Time

Y
N

Part Time

Y
N

Are you currently employed?

Y
N

Position Sought

Preferred Location

Hold NZ Drivers Licence

Full
Restricted
Learner
None

Normal Method of Transport to Work

Own Car
Public Transport
Other

Do you have any convictions against the law?

Other

Industrial & Construction only

Steel capped work boots?

Y
N

Are the caps inside?

Y
N

Do you have any dependants?

Y
N

Do you smoke?

Y
N

Health

Have you had?

Asthma

Y
N

Bronchitis

Y
N

Dermatitis or eczema

Y
N

Hernia

Y
N

Back injury or strain

Y
N

Blackouts or seizures

Y
N

ACC compensation

Y
N

Do you suffer from?

Earache, deafness

Y
N

Skin infections

Y
N

High blood pressure

Y
N

Heart problems

Y
N

Diabetes

Y
N

Any allergies

Y
N

Colour blindness

Y
N

OOS (RSI)

Y
N

If yes, dates of incidents

Details

I have marked all the relevant boxes above which relate to my personal health*

Y
N

Do you wear corrective lenses?

Y
N

Are you taking drugs or medicine?

Y
N

Details

How many sick days have you taken in the past 12 months?

Please give details of anything else which might affect your performance, or which the Company should know about

APPLICANT REGISTRATION form

Citizenship

If not NZ Citizen or Resident

Work Sought

Hold NZ Drivers Licence

Industrial & Construction only

Health