Application for Employment

Personal Information
Name:
Preferred ph:
Alternative ph:
Email:
Address:

Date of birth:
When are you able to start work :
Preferred area of work:	Bakery packaging Beverage packaging Other	Beverage packaging Warehouse
1. Are you legally entitled to work in New Zealand?		Yes	No
2. Have you been convicted of any offence against the law in the last 7 years or do you have any criminal charges pending (apart from minor speeding or parking offences)?		Yes	No
If yes, please give details...
3. Have you had an injury, disability or illness that could be further aggravated by any tasks you may be required to perform? (Note: this information is required to assist us in meeting our obligations to provide a safe workplace for staff. Declaration of a medical condition will not rule you out of consideration)		Yes	No
If yes, please give details...

Employment & Qualification Details
Employer 1 (most recent)
Dates employed
Position held
Reason for leaving
Employer 2
Dates employed
Position held
Reason for leaving
Employer 3
Dates employed
Position held
Reason for leaving

Please list qualification received:



Do you have current certification for:	First Aid	Forklift licence

Referees
Referee 1
Daytime contact
Relationship
Referee 2
Daytime contact
Relationship

The Privacy Act 1993: The information which you supply on this application form and as part of your application is solely to assess your suitability for employment with Tasman Bay Food Group. Failure to complete all sections truthfully will render this application invalid and, should you have been successful in your application, may be grounds for dismissal. This information will be held in Tasman Bay Food Group’s personnel files. No information will be disclosed to third parties without your authorisation unless required by law. You have the right to view your personal information in the presence of the manager and may request correction if necessary.
Authority & Declaration: I hereby authorise Tasman Bay Food Group to collect such personal information about me from the named referees as is necessary to assess my suitability for employment with Tasman Bay Food Group and I authorise Tasman Bay Food Group to disclose such personal information as is necessary for the same purpose. I also authorise the named referees holding such information about me to disclose that information to Tasman Bay Food Group for the same purpose.
I hereby declare that I have read the above Privacy Act statement and I am aware of my rights under the Privacy Act 1993. I certify that the information provided is correct and no information has been omitted.
Signed	Yes
Date
We will hold your application for a period of three months and will contact you for an interview should any suitable roles become available.

Application for Employment

Personal Information

Employment & Qualification Details

Referees