Wild South - Job Application Form:

Position Applied for:      (required - please include location)

Personal Information:

Name:                         
Address:                    
E-mail:                                     Date of Birth:    
Ages of dependent children (If any):  
Are you a New Zealand Citizen?                                                Yes                  No    
If no, do you have a valid working Visa for New Zealand?       Yes                  No    
Working Visa expires:
Do you hold a current valid New Zealand drivers license?        Yes                  No    

General Questions:

Have you ever been dismissed and or given a warning for serious misconduct at any time? 
Yes                  No    
If Yes - give further information  

Have you been convicted of any criminal offence in the last 10 years?                                     
Yes                  No    
If Yes - give further information  

Or do you have any criminal action against you pending?                                                        
Yes                  No    
If Yes - give further information 

Working Hours:

Are you prepared to work nights?                                          Yes                  No    
Are you prepared to work Saturdays?                                   Yes                  No    
Are you prepared to work Sundays?                                     Yes                  No    
Are you prepared to work varying hours?                             Yes                  No    

Medical:

Have you had compensation for any injury through ACC?          Yes                  No    
If Yes - give further information 
Have you ever had a hearing test?                                              Yes                  No    
If Yes - give further information 
Have you ever had a colour blindness test?                                Yes                  No    
If Yes - give further information 
Are you taking drugs or medication?                                             Yes                  No    
If Yes - give further information 
Do you wear corrective eye lenses?                                             Yes                 No    
Have you ever had any back injuries?                                           Yes                 No    
Do you smoke?                                                                               Yes                 No    

Do you currently have, or have ever had any medical conditions, phobias, physical disabilities, mental illness or other conditions that we should be aware of that would inhibit you in any way from performing the position applied for?    Yes                  No    

If so give full details  

Referees:

People we may contact for reference (must include person(s) you reported to in a working environment).
Name/Position/Contact Address/Phone Number

Referee 1:

Referee 2:

Referee 3:

Attach C.V or specified questions:

Please click browse to attach your C.V. Please supply in Word Document, PDF or plain text format only. Document will be attached when the below "submit" button is checked.

Attach Cover Letter:

Please click browse to attach your cover letter. Please supply in Word Document, PDF or plain text format only. Document will be attached when the below "submit" button is checked.

Declaration:

I certify that I have answered all the questions herein to the best of my knowledge and the answers I have given and any documents submitted in respect to this application are true and correct.  I understand that any position I may be offered will be based on the answers and details I have provided and that should any false information be given or material fact suppressed I may not be accepted, or if I am employed, I may be dismissed.

Agree  Disagree