EmailMe Form - SECURE DSP APPLICATION FORM

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone *

Mobile

Email *

Next of Kin

Name and Relationship to you

Phone

Address if different from yours above.

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Required Information

Birthday *

DD / MM / YYYY

Nationality *

Do you have any animal allergies?

Do you, or have you suffered from depression?

Yes

No

Do you currently take any medication?

Yes

No

If you answered yes to either, please give details?

Marital status

Gender and age of your children, if any

Do you currently practice any religion?

Yes

No

Which religion?

Languages Spoken

Please list other spoken languages

Job Preferences/Availability

Ideal pay rate $ *

Date you are available from

If TEMP only, list dates you are available

List days or hours you are NOT available

Minimum hours per week

Maximum hours per week

Areas you are available to work in *

If other, please state

Tick as many as you are seeking

Licence

What drivers licence do you hold?

Learners

Restricted

Full

None

If on restricted licence, when will you have your full?

If you own your own car, what is the make and model?

Eligibility for work in NZ

Please choose your eligibility

If on a visa, please provide passport number

Visa expiry

DD / MM / YYYY

If you have ticked anything other than "NZ born citizen, you will need to supply a certified copy of your passport. Or bring your passport in with you to your appointment.

Please include all relevant qualifications

Qualification, training institute and year completed

What type of work are you looking for?

If other, specify which industry

Areas of experience and willingness
(please only complete sections that apply to you)

Childcare age group experience

Tick as many as apply

At most, how many children at any one time have you been responsible for?

List any twins & triplets experience

Is there anything that would affect you working with children?

Yes

No

Special needs experience

Tick as many as apply

Cleaning/Housekeeping duties (prepared to do)

Tick as many as apply

Eldercare duties (prepared to do)

Compulsory information from all candidates

Do you smoke? *

Yes

No

Do you have a police record or have you ever had one of any description? *

Yes

No

Do you suffer from back pain? Or any type of pain? *

Yes

No

If you answered yes to any of these, please give details

Tell us a bit about yourself

Enter a bit about yourself here

Referees - please list even if they appear in your CV. If international references are listed please enter a private domain email address as opposed to a generic domain like Yahoo, Hotmail or Gmail. Likewise a landline number is preferable.

Referee 1 name *

First Last

Phone or email.

What capacity do they know you? *

Referee 2 name *

First Last

Phone or email

What capacity do they know you? *

Referee 3 name

First Last

Phone

What capacity do they know you?

Upload CV (optional)
must be .doc or .pdf format

I accept the terms and conditions posted on previous page *

Yes