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Application Form

This information is collected for the purpose of assessing your suitability for employment. Applicants must complete this form themselves, answer all questions and complete the declaration.

Position Applied For:

Job Reference:

About You

Full Name:

Address:

Phone Number:

Email:

Have you worked for CORDE before?

Yes No

Health

If relevant, are you prepared to be clean shaven for the purpose of correctly fitting respirator/mask?

Yes No

Have you had an injury or medical condition caused by gradual process, disease or infection (for example hearing loss, sensitivity to chemicals, DPI or depression or anxiety) which the tasks of this job may aggravate or contribute to?

Yes No

More info:

Do you have any health or physical conditions, which may affect your ability to effectively carry out the functions and responsibilities of the position applied for?

Yes No

More info:

I agree to attend a medical practitioner when requested by the above named employer:

Yes No

Licence Details

Do you have a valid full drivers licence?

Yes No

Licence class:

Do you have any demerit, endorsements or been convicted for any traffic offences during the last 5 years?

Yes No

More info:

Entitlement To Work

Are you an Australian or New Zealand Citizen?

Yes No

Are you legally entitled to work in New Zealand?

Yes No

Do you hold an NZ residency visa, temporary or student work permit?

Yes No

Please upload a picture of your visa/permit:

Convictions

Have you ever been convicted of a criminal offence within the last seven years? (outside of the Clean Slate Scheme)

Yes No

More info:

Are there any other matters relating to you currently under investigation by the police?

Yes No

More info:

More info:

Please provide your CV/Cover Letter

CV Upload

Cover Letter Upload (Optional)

Please list any qualifications you have related
to this application (incl all certificates eg. first aid, spray etc):

References

Name:

Nature of relationship:

Phone number:

Do not contact

Remove Reference

Add another reference

Referral

How did you find out about this job?

If you are being recommended by a current
employee, please state their name:

Declaration

I declare that the answers to the questions in this application are true and correct. I understand that if any of the information is proved to be false or misleading or any relevant information is left out of this form or any other supporting documents, this may lead to my application being rejected or if appointed to a position, I may be subject to the appropriate process which could result in dismissal. I also consent to CORDE seeking verbal or written information on a confidential basis about me from my referees. I authorise the information sought, to be released by my referees for the purposes of ascertaining my suitability for this position. I understand that the information to be received by the above named employer is supplied in confidence as evaluative material and will not be disclosed to me.

Yes

Full Name:

Date:

The form was sent successfully.

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85 Hoskyns Road
PO Box 125
Rolleston 7643

connect@corde.nz
03 318 8320

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