Application for Employment

Availability
Monday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Tuesday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Wednesday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Thursday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Friday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Saturday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Sunday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option

References

Please list referees that the Focus Marketing can contact to discuss you and your ability to perform the role.
Reference 1*

First NameLast Name
Company Name*
Position*
Email Address*
example@example.com
Phone Number

Area CodePhone Number
Reference 2*

First NameLast Name
Company Name (CURRENT EMPLOYER )*
Position*
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Do you authorise Focus Marketing to contact your previous employer(s) to obtain references about you?*

YESNO
If no, please indicate why:
Have you ever been disciplined for dishonesty?*

YESNO
Have you ever been dismissed from employment, or been the subject of an investigation that resulted in your resignation?*

YESNO
If you have answered yes to either of the above questions, please provide details:

PRE-EMPLOYMENT INFORMATION

HEALTH

The following information is required to assist Focus Marketing meet its obligations under the Health and Safety in Employment Act 1992 and the Accident Compensation Act 2001 and to assess your ability to perform the role for which you are applying.
Have you had an injury or medical condition, including any surgery in the past caused by gradual process, disease or infection – for example repetitive strain injury – which the tasks of this job may aggravate or contribute to?*

YESNO
If yes, please give details:
Have you any conditions, which may affect your ability to carry out effectively and safely the functions and responsibilities of the position for which you are applying? (Please refer to the position description)*

YESNO
If yes, please give details:
Note: In some situations, further specific medical information relating to the requirements of the job will be needed. Therefore, before being offered employment, you may be required to undertake a pre-employment medical examination and/or authorise the release of relevant ACC claims history relating to yourself. In this case, a satisfactory report will be a condition of employment.
Do you agree to undergo a pre-employment medical examination if required?*

YESNO

CRIMINAL AND TRAFFIC CONVICTIONS (SECURITY)

The first question below is subject to the provisions of the Criminal Records (Clean Slate) Act 2004. This Act gives eligible individuals the right, in some circumstances, to withhold information about their convictions. Detail on what information can be withheld is available : http://www.justice.govt.nz/publications/global-publications/c/criminal-records-clean-slate-act-2004-english-corp- 060/publication
Have you been convicted of any office against the law in New Zealand or in another country?*

YESNO
If yes, please give details:
Do you have any criminal charges pending?*

YESNO
If yes, please give details:
If this is a requirement for the role you are applying for, would you authorize Focus Marketing to request for criminal convictions held on the Ministry of Justice’s computer systems? In this case, we would request you to complete all the questions from Step 2 on – start with “Your details” https://www.justice.govt.nz/assets/Documents/Forms/CRC-request-by-third-party.pdf*

YESNO

CONFLICT OF INTERESTS

To ensure that Focus Marketing can operate in an impartial manner, it is necessary for individuals to:
• declare whether they have any potential conflicts of interest;
• confirm that they will not misuse any knowledge of information they obtain while employed by Focus Marketing.

Situations that may lead to a conflict of interest include:
• secondary employment with other organisations;
• involvement in other businesses that work in opposition, or provide services to the organisation;
• family or close personal relationships with staff and/or clients.
On these grounds, do you have any potential conflicts of interest?*

YESNO
If yes, please give details:
Please submit a copy of your valid passport*

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Please submit a copy of your VISA

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Upload Resume*

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DECLARATION

I certify that the information I have given in this application and any accompanying CV is true and correct. I declare that I have not withheld any information that could affect Focus Marketing’s decision to employ me. I understand that if I have given information that is in Focus Marketing ‘s opinion materially incorrect, inaccurate or misleading, or if I have left out any important information, or if the results of my criminal check are unsatisfactory I may not be considered for appointment, or if appointed my employment may be terminated or cancelled.

I declare that my reasons for leaving my former and/or present employment are fully detailed in this application. I have declared to Focus Marketing any formal disciplinary action taken against me by such employers. I confirm that no such employer has accused me of dishonesty or breach of the duties owed by me to that employer. I accept that my employment agreement with Focus Marketing may be immediately terminated or cancelled in the event of this information being incorrect in any respect.

I acknowledge that the information given by me in connection with this application may be discussed with my referees and previous employers, and I agree to them being contacted. I understand that the information gained from this will be held in confidence and will not be available to me.
Signature*

Clear
Date*

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Date
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References