1. APPLICATION FOR APPOINTMENT
Position Applied for: Vacancy Number:
Location: Closing Date:
Last Name: Preferred Name:
First Name(s) in full:
Are you a current Ministry employee? ο No ο Yes
If yes, employee ID if known ………………………………….
Full Postal Address: Contact details (tick preferred method of contact):
ο Phone No. (day)……………………………..
ο Phone No. (evening)………………………..
ο Cell Phone…………………………………...
ο Email address………………………………...
Please complete the following questions in full.
Are you a New Zealand citizen? ο No ο Yes
If No, do you have (please tick as appropriate):
(please note that if you are not a New Zealand citizen
ο No ο Yes Permanent Residency status
you will be required to prove your residency status or
show your work permit prior to being confirmed to the ο No ο Yes A current temporary work permit
position)
Work Permit / Visa Expiry Date: _____/_____/20___
Convictions: Have you ever been convicted of a ο No ο Yes (please provide details)
criminal charge? …………………………………………………………………………
…………………………………………………………………………
ο No ο Yes (please provide details
Have you any criminal charges pending?
…………………………………………………………………………..
…………………………………………………………………..
Outstanding Fines: Do you have any unpaid fines or ο No ο Yes (please provide details)
outstanding reparations owing? If yes, you will be
…………………………………………………………………………
required to pay the fine and/or outstanding reparation
…………………………………………………………………………
in full prior to being confirmed into this position
Driving: (please complete where driving may be a
ο No ο Yes
requirement of the role). Are you currently legally
entitled to drive in New Zealand?
Have you been convicted of any driving offences? ο No ο Yes (please provide details)
……………………………………………………………………
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