EmailMe Form - EMPLOYMENT APPLICATION FORM

How did you hear about us? *

If other, please specify:

Personal & Contact Information

Full name *

First Middle Last

Address

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

Email *

Phone *

Additional information

Position applying for: *

If your application is successful, when could you start employment? *

Drivers Licence

Please attach a colour copy of both sides of your drivers licence below.

Do you have a current New Zealand drivers license? *

Yes

No

Upload your drivers license:

CV & Cover Letter

Please attach your CV and Cover Letter below.

Upload your CV: *

Upload your Cover Letter

Contact with previous employers and/or referees *

Yes

No

I consent to Mills Albert Limited seeking verbal or written information on a confidential basis about me from representatives of my previous employers and/or referees. I authorise the information sought to be released to you for the purpose of assessing my suitability for employment for the position applied for. It is understood that the information supplied will be considered to be evaluative material and will not be disclosed to me personally.

Medical Information

Following the completion of pre-employment checks, if you are offered employment the offer may be subject to you agreeing to first participate in, and pass, a professionally conducted and measured general medical examination and/or drug and alcohol screening tests.

If requested, would you be agreeable to participating in these tests? *

Yes

No

Do you have any injury or illness that could affect your ability to perform manual tasks? i.e. hand tools, shovelling, etc. *

Yes

No

If yes, please detail below:

Eligibility to Work in New Zealand

Are you either a New Zealand citizen, a permanent resident or have a current work permit? Please specify: *

Criminal Offences

Have you ever been convicted of a criminal offence (excluding any offences covered by the Criminal Records (Clean Slates) Act 2004)? *

Yes

No

Are you awaiting the hearing of charges in a civil or criminal court of law? *

Yes

No

Declaration

It is declared that to the best of my knowledge the answers in this application are complete and correct and I understand that if any false or deliberately misleading information is supplied, or any material information is suppressed, I will not be accepted, or if employed, my employment maybe terminated. I also understand that any false information given in relation to medical history and gradual disease, infection, impairment or injury that could affect my performance of duties can result in my loss of entitlement for any compensation for ACC. *

Yes

No

Please upload an electronic signature for this declaration:

Date *

MM / DD / YYYY