Employment Application Form

CONFIDENTIAL
To be completed personally by Applicant

Please Note:
The completion of this form does not indicate that there is any obligation on jigsaw whanganui to engage the applicant. The application form is a source of information, which will be used by jigsaw whanganui to assess your suitability for the position for which you are applying. If successful, this information will form part of our personnel records. Failure to supply the information requested would prejudice our ability to assess your suitability for the position
Date of Application*
DD dash MM dash YYYY
Position applied for*

PERSONAL DETAILS
Family name:*
First/Middle names:*
Residential Address:*
Street Address Address Line 2 City ZIP / Postal Code
Is your postal address different from your residential address?*
- Yes
- No
Postal Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Numbers*
Email*
Are you a New Zealand citizen?*
- Yes
- No
Do you have the right to work in New Zealand?*
- Yes
- No

TERTIARY QUALIFICATIONS:
TERTIARY QUALIFICATIONS
Qualification Year Gained Institution

Please fill in the below - click the "+" button to add more qualifications
Are you registered with a professional body?*
- Yes
- No
If yes, please specify:*
Have you ever been subject to a formal complaint regarding your professional practice?*
- Yes
- No
If yes, please detail:*
What languages do you speak?
Please describe the skills you have which are relevant to the position applied for:*
If your application is successful when could you commence employment?*

REFEREES
REFEREES*
NAME POSITION PHONE NO E-MAIL

Please provide name and contact details of at least three referees who have known you for more than two years. (Two need to be employment related)
LEGAL
Have you been convicted of a criminal offence?*
- Yes
- No
Have you ever been the applicant or respondent to a Protection Order?*
- Yes
- No
Are you awaiting the hearing of charges in a civil or criminal court of law?*
- Yes
- No
If YES to any of the above, please give details:*
TRANSPORT:
Do you have a current driver’s licence?*
- Yes
- No
Do you have any demerit points or endorsements?*
- Yes
- No
If yes, please detail:*
Do you have the daily use of a reliable, registered, warranted and insured vehicle*
- Yes
- No

Health
Have you ever suffered from any illness or injury requiring extended time off work?*
- Yes
- No
If yes, please detail:*
Have you had any serious injury, physical or mental illness or other condition now or in the past that may affect your ability to effectively carry out the functions and responsibilities of this position*
- Yes
- No
If yes, please explain:*
Have you ever had problems at work arising from personality clashes, or conflicts with management and/or other staff?
- yes
- No
If yes, please explain:*

DECLARATION
1. I agree with Jigsaw Whanganui discussing this application in confidence with my referees
2. I consent to the safety checking requirements of the Vulnerable Children’s Act 2014 including NZ Police vetting
3. My answers in this application are true and not misleading, and there is no further relevant information I have not included
4. I understand that if Jigsaw Whanganui employs me they are relying on the truth and completeness of my answers, and therefore may terminate my employment immediately and without notice if I have not answered truthfully and completely
I agree with all of the above and that i have answered all questions correctly and honestly to the best of my knowledge*
- Yes
- No
Upload your CV
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Please upload either a PDF or Word Document - files size can be no larger then 20MB
Upload a cover letter
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Email
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Qualification	Year Gained	Institution

NAME	POSITION	PHONE NO	E-MAIL

PERSONAL DETAILS