This application form is a source of information that will be used by People4Success to assist in considering your suitability for the positions as they become available and such information shall form part of People4Success records. 
By completing this information you consent to People4Success and any subsequent employer you are introduced to via People4Success being able to investigate and insist on your compliance with the consents given herein.

Note: The completion of this form does not indicate that there is any obligation on People4Success to engage the applicant.  Where you have supplied People4Success with a CV detailing some of the particulars requested, please simply indicate in the appropriate space that the CV contains this information.

Please enter your details below. Fields marked with a * are required and must be completed
First Names*
Surname*
Password*
Personal Information
Email Address
Are you known by any other name? If yes, Please specify
Address*
Mobile*
Home Phone
Work Phone
How did you hear about People4Success*
Word of Mouth    Newspaper    Telephone Book    Website    
Internet Search             
Other, Please specify
Upload CV
Covering Letter
Photo (FirstName-LastName.jpg)
Work Preferences and Availability
Type of Employment Sought*
Administration, Secretarial and customer service
Accounts and Finance
Driving, warehousing and logistics
Engineering
IT
Factory and Labouring
Hospitality and Leisure
Managerial and Executive
Other professional
Medical, Health and social services / care
Retail and Sales
Trades incl. Apprenticeship and Trainee positions
Farming
Type of work sought*
Full time    Part time    Temporary    Casual    
Preferred Geographical area*
Te Awamutu    Otorohanga    Hamilton    Cambridge    
Waikato    North Island    South Island       
Other areas
Preferred number of hours per week
Preferred Days per week*
Monday    Tuesday    Wednesday    Thursday    
Friday    Saturday    Sunday       
Are you willing to work additional hours if required*
Yes    No          
Are you prepared to do shift work including night shift*
Yes    No          
Remuneration Sought*
<$30
$30-$40k
$40-$45
$45-$50
$50-$55
$55-$65
$65-$75
$75-$90
$90+
If your application is successful when could you start work*
Other start dates, please specify
Please list any other agencies you are registered with
Residence Status
What is your status in New Zealand*
Citizen
Permanent Resident
Work Permit
Can you produce evidence if required*
Yes    No          
If you have a work permit please indicate the expiry date and any restrictions
Are you an assistant immigrant under bond to the NZ Government or any other employer
Yes    No          
If yes do you have the authority to accept other employment

Please Note that you will be required to produce evidence of your situation to People4Success.
General
Do you have a current NZ drivers licence*
Yes    No          
Vehicle Classes Held
  No License  
Class 1 - car license:      Learner      Restricited      Full
Class 2 - medium rigid vehicle:      Learner      Restricited      Full
Class 3 - medium combination:      Learner      Restricited      Full
Class 4 - heavy rigid:      Learner      Restricited      Full
Class 5 - heavy combination:      Learner      Restricited      Full
Class 6 - motor cycle:      Learner      Restricited      Full
F - Forklift Yes  
OSH Certificate - Forklift Yes  
R - Rollers Yes  
T - Tracks Yes  
W - Wheels Yes  
DG - Dangerous Goods Yes  
If applicable, please list any license endorsements you have (ie passenger, vehicle recovery, instructor or testing officer)
Do you have any demerit points
Yes    No          
Has your licence ever been endorsed or subject to fine / prosecution or special conditions
Yes    No          
If yes give details
Do you have any cases pending that could affect your licence*
Yes    No          
Have you ever been convicted of a criminal offence*
Yes    No          
If yes give brief details
Are you currently awaiting the hearing of charges in a civil or criminal court of law*
Yes    No          
If yes give brief details
Have you been through a disciplinary process with any previous employer*
Yes    No          
Have you ever had a personal grievance or any other kind of employment dispute with a previous employer*
Yes    No          
Medical
Do you have any condition, including gradual process, disease, illness, disability or infection which may affect your ability to effectively and safely carry out employment of the type you wish to pursue*
Yes
No
If yes please detail
Do you agree to undergo workplace drug testing at any time prior to or after employment if required by any employer you are placed with through People4Success*
Yes    No          
Do you agree to undergo a medical examination at anytime prior to or post employment*
Yes    No          
Do you require corrective lenses or contact lenses*
Yes    No          
Do you consent to any relevant testing for the purposes of Health and Safety monitoring during your employment*
Yes    No          
Have you ever suffered from any accident or injury requiring time off work from a role similar to that which you are currently seeking*
Yes    No          
If yes give details
In your past employment have you ever been exposed to Noise (excessive or prolonged periods) Asbestos, Poisonous Metals (lead, mercury, other toxic metals), Solvents, Skin irritants, Infectious materials*
Yes    No          
If yes please give details
Declaration
I declare that, to the best of my knowledge, the answers that I have provided to the questions in this application form are correct and I understand that if any false or deliberately misleading information is given or any material fact suppressed, I will not be accepted for employment. If such information or fact is discovered after I have been employed, my employment will be terminated. I also understand that any false information given in relation to my medical history may result in my loss of entitlement for any compensation from ACC.*
Yes    No          
I further declare that I agree for People4Success to use non-identifying information to promote me to prospective employers via their website or other medium*
Yes    No          
Newsletter
Yes, I would like to subscribe to the newsletter