Employment Application Form

Employment Application

Fill the form below accurately indicating your potentials and suitability to job applying for.
Name: *

First Name Last Name
Date of Birth *

Day Month Year
Phone Number *

Area Code Phone Number
E-mail Address *

Address *

Drivers Licence Type *
Drivers Licence Number
Upload Photo ID - Drivers License (FRONT) or Passport
Upload Photo ID - Drivers License (REVERSE)
Criminal Convictions - Past or Pending *
Upload Police Vetting form *
To download and complete Police Vetting form to upload click here. (Will open in new window.)
Work Entitlement
Work Entitlement - Please tick *

New Zealand Citizen Permanent Resident Holder of a current work permit
If you are the holder of a work permit please provide details:
Type of Work Permit
Student / Open / Other - please state
Work Permit Number
Permit Expiry Date

Day Month Year
Date Date Picker Icon
Number of hours permitted to work each week

: Hour Minutes
Availability

Please tick or indicate hours available eg 7am – 2pm. Yes/No for Sleep/Wakeovers *

We use the Netsoft System which can use a mobile app to log in and out of shifts if you have a smart phone.
Do you have a smartphone? *

No Yes, Android Yes, iOS (iPhone) Yes, Windows
First Aid
Do you have a current First Aid Certificate? *

Yes No
Expiry Date

Day Month Year
Date Date Picker Icon
Job Skills & Training
Provide details of completed training / qualifications *
Upload training / qualifications
What skills do you have? *

Housework Meal preparation Child Care Shopping/errands Showering female clients Showering male clients Dressing/Undressing clients Hoist work Palliative Cares Catheter Cares Bowel Cares Experience with pressure sores Exp with Serious Spinal injury clients Exp with Brain injury clients
What experience do you have? *

Nursing/Rest Home experience General hospital experience Teaching Early Childhood qualification Previous Support Work Community Nurse Foster Parent Personal/Family Care experience Tertiary Qualification Social Worker Mental Health Student Nurse
Upload CV
Health Questionnaire
Have you ever claimed ACC? (If yes please give details)
Are you currently receiving medical treatment and/or taking medication? (If yes please give details)
Is there any medical condition that could affect your ability to fulfill your obligations to our clients? (If yes please give details)
Past Employment
Present or Last Employer Name *

Address *

Phone Number *

Area Code Phone Number
Position held *
Date commenced

Day Month Year
Date finished

Day Month Year
Duties / Responsibilites
Reason for leaving
Can we contact them? *

Yes No
References

Please list two (2) references that are familiar with your work life.
Reference 1
Name: *

First Name Last Name
Relationship *
E.g. Manager, Co-worker, Family member etc
Company
Phone Number *

Area Code Phone Number
Email Address
example@example.com
Reference 2
Name: *

First Name Last Name
Relationship *
E.g. Manager, Co-worker, Family member etc
Company
Phone Number *

Area Code Phone Number
Email Address
example@example.com
Head and shoulders photo
Please upload your head and shoulders photo here
- References: your CV must provide at least two referees, with one being a current or previous employer that we have permission to contact. Please do not use a family member as a referee.
- We also complete a Police Check and a police vetting form must be completed
- Please include a recent head and shoulders photo for an Identification name badge to be made.
I have uploaded (please tick)

Photo ID CV Police Vetting form Head and shoulders photo
Should be Empty: