Fillable Printable PAK'nSAVE Kapiti Application for Employment Form

PAK'nSAVE Kapiti Application for Employment Form

APPLICATION FOR EMPLOYMENT

CONFIDENTIAL

Please take the time to personally complete this application (please print). If you require any

special assistance to complete this form please advise us of your requirements. If including a CV,

please do not send original documents as CVs will not be returned.

The completion of this application does not indicate that there is any obligation to engage or

employ the applicant.

This information is collected for the purpose of assessing your suitability for employment with

Kapiti PAK’n SAVE. If your application is successful, this form will be retained in your personal file.

___________________________________________________________________________________

Position applied for: ________________________________ Date of Application: _________________

PERSONAL INFORMATION

First Name(s): ___________________________________ Surname: ___________________________

Preferred title: MR/MRS/MS/MISS Contact Number: _______________________________________

Cell Number: ___________________________ Date of Birth: _________________________________

Address (Residential): _________________________________________________________________

Email Address: ______________________________________________________________________

Name of person to be contacted in case of an emergency: ___________________________________

Relationship (eg. Mother): _________________________ Contact Number: _____________________

EDUCATION

Highest Education Level attained (eg. NCEA level/University/Tech etc.): _________________________

___________________________________________________________________________________

Do you hold any relevant NZQA certificates or other industry related qualifications? YES / NO

List below (eg. Food Safety, Health and Safety, Customer Service):

_____________________________________________________________________________________

SKILLS AND EXPERIENCE

Please outline below your skills and experience relevant to this position:

___________________________________________________________________________________

EMPLOYMENT HISTORY

Please list your previous work experience below (start with most recent and list all positions):

Date from

Date to

Position/s

Company

Work Responsibilities

Reason for leaving

REFEREES

Please give the details of three referees that you authorise us to contact. Preferably two work-related

referees and one personal referee.

Name Position/Company Relationship Phone No. (Work) (Mobile)

___________________________________________________________________________________

AVAILABILITY

Please note we are a 7 day business. It is extremely seldom that a Mon-Fri position is available. All

part time positions will include a Saturday or Sunday.

Days & approx. hours available to work: __________________________________________________

___________________________________________________________________________________

Do you have any commitments that may interrupt your regular attendance at work? YES / NO

If yes, please list details: _______________________________________________________________

Are you able to work your rostered hours and any overtime as required, ie. Stocktake YES / NO

If your application is accepted, when could you commence employment? _______________________

Do you have any prior obligations requiring your absence from work? __________________________

GENERAL

Do you have a current drivers licence? YES / NO What class? ____________ Licence No. __________

Do you have a partner/relative/household member working elsewhere in this company? YES / NO

Do you have a reading or writing disability? YES / NO

Have you ever been the subject of a disciplinary issue at your previous employment? YES / NO

Do you have the legal right to work in NZ, with permanent residence or a valid work permit?

(Evidence will be required if you are interviewed for this position) YES / NO

Note: Failure to have clear evidence of being legally able to work in New Zealand or providing false information or

misrepresenting your eligibility to work in New Zealand may result on any employment being terminated or an offer of

employment withdrawn.

Have you ever been charged or convicted of a criminal offence? YES / NO

Do you consent to a Ministry of Justice check if requested as a condition of employment? YES / NO

How did you hear about this job? _______________________________________________________

(eg. TradeMe, Seek, Foodstuffs, Newspaper, Facebook)

HEALTH AND SAFETY

Are you prepared to work as and where directed? YES / NO Do you smoke? YES / NO

Are you prepared to abide by safety and work rules? YES / NO

MEDICAL

Have you ever had any injuries or illnesses that have arisen from employment? YES / NO

If yes, please give details: ______________________________________________________________

Do you take any regular medication? YES / NO

If yes, please give details: ______________________________________________________________

Have you had any injuries or illnesses including OOS, RSI, Back Strain etc. that were compensated by

ACC or a private insurer? YES / NO

If yes, please give details: ______________________________________________________________

Do you require any special services or facilities that enable you to carry out work duties? YES / NO

Do you have any condition that may affect your ability to carry out effectively the functions and

responsibilities of this position? YES / NO

If yes, please give details: ______________________________________________________________

PRIVACY ACT CONSENT

Do you consent to the Company retaining the information contained in this application for the

purposes of considering your suitability for other positions which may arise with this Company in the

future? YES / NO

DECLARATION

I, ________________________________________________ (full name)

1. Declare that the answers to the questions in the application are true and correct, and I

understand that the information requested within this application form is sought to establish

my suitability for the position that I am applying and that if I do not provide such information

then this application for employment may be rejected.

2. Authorise any screening processes Kapiti Pak’n Save sees fit to exercise in considering this

application. I understand this process may include verifying previous employer references

and checking of criminal and medical records.

3. Understand that I may be required to have a drug test at any time during my employment.

4. Agree to undergo any required employment assessments.

5. Will provide a current cell phone contact number and agree to have a photo taken.

6. Accept that, should my application be successful, the foregoing information will form

part of my contract of employment and falsification of any information is grounds for

dismissal.

Signature: _________________________________________ Date: ______________________

Thank you for applying for a position at Kapiti PAK’n SAVE.

Notes: