Employment Application Form

Date

Position applied for

Personal Details:

Full name

Date of birth

Address

Home phone

Mobile phone

Email address

Education:

Schools Attended & Dates

Occupational, Trade or Professional Qualifications

Please list qualifications (STMS Level 1, STMS Level 2/3 NP, STMS Level 2/3 P, STMS Trainer, other)

Drivers Licenses

Please list licenses (car, HT, other)

Employment History

Employer 1

Dates employed

Position held

Key responsibilities

Employer 2

Dates employed

Position held

Key responsibilities

Employer 3

Dates employed

Position held

Key responsibilities

Other employment or experience relevant to this application

Pre-Employment Declaration

Are you entitled to work in New Zealand
Yes No

If yes, please select your current status from the following:
New Zealand Citizen
Permanent Resident
Current Work Permit, expiry date:
None of the above, please explain:

Do you have, or have you ever had, an injury or medical condition caused by gradual process, disease or infection which the tasks of this job may aggravate or contribute to, or which may affect your ability to carry out the work of the position applied for?
Yes No

If yes, please explain:

Do you have any special health requirements such as allergies, illnesses, disabilities or back or limb problems which need to be taken into account in workplace planning?
Yes No

If yes, please explain:

Are there any restrictions on your ability to work flexible hours (early starts, nights, weekends etc) as required from time to time?
Yes No

If yes, please explain:

Drugs and Alcohol Policy

We have a policy of zero tolerance for illegal drugs and alcohol in our workplace and we undertake pre-employment testing of all applicants being considered for appointment. We also undertake post-accident testing, random testing and testing for reasonable cause. You have an opportunity here to disclose any matters which may impact on any drug tests to which you give consent:

Have you been prescribed any medications whose side effects may impact your work performance?
Yes No

If yes, please explain:

Criminal Offences

Have you been convicted of a criminal offence not covered under the "Clean Slate Scheme"? If so, you are required to disclose this information. If you require information on the "Clean Slate Scheme" it is available from the TTC office.
Yes No

If yes, please explain:

Do you have any criminal charges or driving offences pending or under investigation?
Yes No

If yes, please explain:

Workplace policies

This company enforces a no smoking in the workplace policy. Are you willing to abide by this?
Yes No

Wearing of personal protective equipment (PPE) is compulsory. Is there any reason you can not wear PPE?
Yes No

If yes, please explain:

References

Please supply two names, addresses, phone numbers, and advise their relationship to you.

Work reference

Personal reference

Declaration

By ticking this box I declare that the above information is accurate and I understand that any dishonesty in providing this information may affect any employment agreement reached between myself and Temporary Traffic Control Limited. I also authorise you to contact my nominated references.

I authorise you to collect and store personal information about me in relation to this application for employment to be used for the purpose of assessing my suitability for employment and if successful my employment, and for the purpose of your records relating to all employment matters.

I acknowledge that you have informed me that under the Privacy Act 1993 I have the right to request access to all information you hold about me and to request corrections to that information.