EmailMeForm
Apex Care Screening & Application for Employment
Thank you for applying for a position with Apex Care. Once we receive your application, please know that we'll be in touch soon.
Being a service provider, please note that our contracts are mainly Casual. We do not sponsor work visa applicants.
We look forward to receiving your application.
Name
*
First
Last
Email
*
Date of Birth
*
DD
/
MM
/
YYYY
Phone
*
Today's Date
*
DD
/
MM
/
YYYY
Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Emergency contact
First
Last
Emergency contact Phone No:
How did you hear about Apex Care job advertisement?
*
Do you have previous experience working in the health/mental health or social service sector?
*
Yes
No
Region you want to work in?
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Waikato
Bay of Plenty
Northland
Auckland
Are you willing to travel for work?
*
Do you have previous experience working with youth?
*
Yes
No
Are you a New Zealand Citizen/Resident
NZ Citizen
Residency Visa
If you hold a Residency Visa, please upload it here.
File to be no larger than 2mb
What type of New Zealand Drivers Licence do you hold?
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Learners
Restricted
Full
I do not hold a licence
Please Upload your Drivers Licence, front and back. This forms part of the 2 forms of ID we require.
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File to be no larger than 2mb
Please upload a secondary form of ID e.g. passport.
*
File to be no larger than 2mb
Do you have your own vehicle?
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Yes
No
If required would you agree to a drug/alcohol test?
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Yes
No
Are you prepared to handle all products, materials, or equipment used in the industry?
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Yes
No
Do you have access to the internet and a device for filling in daily notes and accessing your roster.
Yes
No
Please be aware that as part of our checks we do a full Police check, not just a Clean Slate check
Have you had any criminal convictions or faced charges?
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Yes
No
Please be aware that as part of our checks we do a full Police check, not just a Clean Slate check
Are you aware of any medical conditions or infectious diseases that you have that could be passed onto Apex Care clients?
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Yes
No
Are there any aspects of your health you feel should be revealed to ensure your safety at work?
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Yes
No
If yes, please provide details
QUALIFICATIONS and EMPLOYMENT HISTORY
Qualifications Held and Year Completed
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Qualification Name
Date Qualified
Qual 1
Qual 2
Qual 3
Qual 4
Please Upload all your qualification certificates. If you have qualifications, you MUST upload the certificates now. It may delay your application if you don't.
Add File
File to be no larger than 2mb
Do you have a current First Aid Certificate.
*
Yes
No
Please note this is a required certification for the role. If you don't have one, you'll need to obtain this as part of coming on board with Apex Care.
Please Upload your First Aid certificate here.
File to be no larger than 2mb
Employment History (last 5 years)
Company
Position Held
Date from - to
Most Recent Role
Next Most Recent
Next Most Recent
Next Most Recent
References: Employers or Supervisors we can contact. These must be within the last year. If you have worked in the health sector, the references should come from there.
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Name
Company
Position Held
Phone Number
Email Address
Second Reference
*
Name
Company
Position Held
Phone Number
Email Address
Availability - Please mark the days and times you are usually available
AM - eg 7am-3pm
PM eg. 3pm - 11pm
Night - Wake Over and Sleep Over
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Days of the week you are not available, Ie Study, Religious commitments, child care etc.
Do you have any friends or family that work for Apex Care past of present? If so who?
Do you have any planned vacation or need for leave coming up?
If employed by Apex Care, when can you start?
*
Other Employment - Please list below any other employment you will be continuing with whilst working for Apex Care
Please Upload your Cover Letter here if you choose to supply one. Recommended as it's a great way to introduce yourself.
File to be no larger than 2mb
If you do not have a cover letter, then please explain here why you are right for this position.
* Have you ever worked with high needs or complex mental health clients before?
Youth
Elderly
Adults
No
Do you feel confident in supervising medication?
Yes
No
Are you confident in cooking, cleaning and personal cares as required by some of our clients.
Cooking
Cleaning
Personal Cares
Do you have training using hoists?
Standing
Ceiling
Lazy Sue
Please give details of the types of clients you have worked with.
How would you handle a client you were working with if they were known to escalate and become violent?
How would you help somebody to stay motivated to reach their goals?
What are your strengths?
How do you describe/define professional boundaries and how would you make sure they are maintained at all times?
You walk into a client’s room and they are self-harming, how do you react, what do you do?
Do you have Te Reo Māori or any other language? If so please list.
Please Upload your Curriculum Vitae (CV) here.
*
File to be no larger than 2mb
Declaration
- I declare that the above information I have given is true and correct
- I understand this application does not guarantee me work
- In accordance with the privacy laws, I allow Apex Care permission to contact the verbal references I have provided
- I hereby confirm I am entitled to work in NZ
- I hereby confirm I have disclosed all my criminal
convictions, charges or impending charges.
*
Clear
Please sign above