APPLICATION FOR EMPLOYMENT Step 1 of 7 14% 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 positionDate of Application* Position applied for* PERSONAL DETAILSFamily 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 NZ POLICE VETTING TO MEET REQUIREMENTS OF VULNERABLE CHILDREN’S ACTDate of birth* Maiden or any other names usedGender*FemaleMaleOtherCountry of Birth*Place of Birth (town/city):*NZ Driver Licence No:* TERTIARY QUALIFICATIONS:TERTIARY QUALIFICATIONSQualificationYear GainedInstitution Please fill in the below - click the "+" button to add more qualificationsAre 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?* REFEREESREFEREES*NAMEPOSITIONPHONE NOE-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)LEGALHave 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 HealthHave 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 I agree with jigsaw whanganui discussing this application in confidence with my referees I consent to the safety checking requirements of the Vulnerable Children’s Act 2014 including NZ Police vetting My answers in this application are true and not misleading, and there is no further relevant information I have not included 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*YesNoUpload your CVAccepted file types: pdf, docx.Please upload either a PDF or Word Document - files size can be no larger then 20MB Upload a cover letterAccepted file types: pdf, docx.Please upload either a PDF or Word Document - files size can be no larger then 20MB NameThis field is for validation purposes and should be left unchanged.