Join Our Team | Tirau Earthmovers Employment Application

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Employment Application Form 08

Fields marked with an * required
Part 1:

Attached is an Application for Employment Form which you are requested to personally complete.

The Application Form is a source of information that will be used by this business to consider your suitability for the position for which you are applying. If successful, such information will form part of our staff records. Failure to supply the information requested may prejudice our ability to assess your suitability for the position.

In accordance with The Privacy Act 1993, you are entitled to access this information upon request to this company’s Privacy Officer where the information is held.

The staff records are located at 1906 State Highway 1, Putaruru and available on request.

My signature below is acceptance of the above.
Date

MonthDayYear
Date
Digital Signature*

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Part 2:

CONFIDENTIAL To be completed personally by Applicant

Note: The completion of this form does not indicate that there is any obligation on this business to engage the applicant.

PURPOSE

This information is collected for the purpose of assessing your suitability for employment at Tirau Earthmovers Ltd which may include subsequent changes in employment with the company.
Date*

MonthDayYear
Date
Position Applied for*
Titile

MrMrsMiss
Name*

SurnameGiven Names
Preferred Name

Other known names
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone
Please enter a valid phone number.
House Number
Please enter a valid phone number.
Mobile Phone*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Do you have the right to work in NZ?*

YesNo
If yes, what is that right bases upon?
I undertake to provide a copy of my birth certificate; permanent residency or work permit within 24 hours of a request whether verbal or written.
Are you an assisted immigrant under bond to the government or any other employer?*

YesNo
If yes, what are the details?
Education including University further education etc. where applicable
Name of Secondary School/s, Tertiary Institutes attended (From & To)
Qualifications (School Certificate, University Entrance) subjects
List other qualifications
Languages
Can you speak any language(s) other than English?
Skills for Position
Please describe the skills you hold which are relevant to the position applied for (e.g. for a typist - typing speed, word processing capability, shorthand capability, etc.)

Agreement

I agree and accept that by undertaking certain tasks appointed by the company that it does not constitute a job offer or the commencement of employment and I hereby accept that this is part of the job interview.

Declaration:

I declare:

1. That my answers in this application are true and not misleading; and
2.That there is no further information that may be relevant that I have not told you about.

I acknowledge:

1. That if you employ me you are relying on the truth and completeness of my answers and therefore;
2. That if in the company’s opinion I have not answered truthfully and completely, you may terminate my employment immediately and without notice.

I understand:

That false or incomplete answers relating to my medical history could mean that I may compromise my access and receipt of ACC compensation
Name

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

SERVICES

WHAT WE DO
WHO WE ARE
PROJECTS
CONTACT
CAREERS WITH US

TEM MAIN OFFICE

Tirau Earthmovers Main Office
1906 State Highway 1, Putaruru
PO Box 4, Tirau
07 883 8372 – 0800 TIRAU E
Monday – Friday 7am – 5pm
Saturday 8am – 12pm

TEM HAUTAPU

Tirau Earthmovers Hautapu Yard
78 Hautapu Road, Cambridge
07 827 5820 – 0800 TIRAU E

CONTACT

James Ensor – 021493028
Bruce Taylor – 0276638372

	Yes	No
Do you smoke ?
Do you agree to undergo a medical examination relevant to the job if required?
Do you agree to undergo a drugs test if required?
Are you allergic to, or have any sensitivity to any substances or chemicals?
Do you require corrective lenses or contact lenses?
Have you ever suffered from a back injury requiring time off work?

	Yes	No
Nose
Asbestos
Heavy metals
Solvents
Skin irritants
Infectious material

Employment Application Form 08

COMPLETE EMPLOYMENT HISTORY

FURTHER EMPLOYMENT DETAILS

REFEREES

GENERAL

SERVICES

TEM MAIN OFFICE

TEM HAUTAPU

CONTACT