ࡱ> z|y 7bjbjVV 4<<7$ $ ggggg{{{{${X33333vxxxxxx$OZggg33...g3g3v.v...3k{$ .b0.K.K.Kg.4..K$ -: Application Form Applications close on [date] at [time] and should be forwarded to the [name] via e-mail to [email address] or posted to [postal address]. Note The short-listing decision will be made on the information received on this application form. CVs will reaffirm information but will not replace this form. Personal Details: Full name:Contact address:Phone numbers:Mobile:Email:Current drivers licence type: Academic Qualifications (Please attach a copy of your Academic Transcript if available or copies of appropriate qualifications). Year CompletedQualificationUniversity or PolytechSubject Major Other Qualifications/Professional Memberships relevant to the position:  Residency/Citizenship: Are you legally entitled to work in New Zealand?YesNoIf you are legally entitled to work because you have a permit please indicate when that permit expires. If successful with your application we will request a copy of your work permit.Expiry Date Salary Expectation for this position:  Recent Employment Experience: Current/most recent employer:Position held:Nature of business:Notice period required:Period of employment/dates:Reason for leaving or wanting to leave:Duties/tasks relevant to position: Employment History Chronological order after most recent: Employer: Position held:Nature of business:Period of employment/dates:Reason for leaving:Duties/tasks relevant to position: (Repeat above on another sheet if necessary) Please explain any gaps in employment history (for example: full-time study, travel, family commitments etc):  Provide details of computer experience/knowledge etc. and names of various applications/packages used and/or competent on:     RefereesReferee Name (1): Current position: Relationship: Company/Organisation: Contact number: Mobile or evening number if appropriate: Referee Name (2): Current position: Relationship: Company/Organisation: Contact number: Mobile or evening number if appropriate: Have you ever been charged or convicted of a criminal or serious driving offence? Yes/No (this question should not be read as requiring you to disclose convictions that you have the right not to disclose in accordance with the Criminal Records (Clean Slate) Act 2004). If yes please give details: Have you ever suffered from a significant injury or illness that would inhibit you from carrying out the position successfully? Yes/No. If yes please give details:The Privacy Act 1993 The information you supply on this form, together with any CV and other information provided with your application, will be used to assess your suitability for employment. If you do not provide complete and accurate information, your application is likely to be disregarded. If your application is successful, this information will be held in our personnel files and retained for ongoing employment use. No information will be disclosed to third parties without your authorisation, except as required by law or where we consider disclosure is necessary for purposes connected with your employment. If you are unsuccessful, we will not retain the information without your authorisation. You have the right to view your personal information held by [organisations name] and may request for it to be corrected if necessary. Acknowledgement and consent I have read the above Privacy Act statement. I authorise [organisations name] to collect and disclose personal information about me and from me as is necessary for the purposes set out in the above statement. I also authorise [organisations name] to use the information that I have provided, should I be appointed, for any purposes connected with my employment. I confirm that the information provided in this application form and in any supporting documents or verbally provided as part of my application is accurate and correct and no material information has been omitted. I understand that any incorrect, misleading or omitted information may disqualify me for appointment, or if I am appointed, may lead to the termination of my employment. 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