Position applied for Date First Name Last Name Education What secondary school did you attend? What is the highest level you achieved at secondary school? Did you attend University/Polytechnic or other Tertiary Education? Yes No If Yes, what institution & what qualification/s did you complete? Do you speak any languages other than English? Contact/Visa Details Phone Number Email Address Are you a New Zealand Citizen/resident Yes No Do you have a valid Work Visa? Yes No Not Applicable Do you have any Visa Restrictions eg time restrictions? Work Experience - Please list the last 3 employers you have worked for, the date commenced, the date finished at the position you held. Employer 1 Information Employer 2 Information Employer 3 Information General Questions Do you have any illness or injury that may impact your ability to competently or prevent you from completing any aspect of the position? Do you take any prescribed medication that may impact on your ability to complete any aspect of the position? How much sick leave did you take in the last 12 months of employment? Have you had any ACC claims in the last 5 years? If so please provide details. Have you ever been convicted for any criminal or dishonesty crimes? If yes, please provide details. Have you ever been investigated for or charges laid for any criminal allegation? If yes, please provide details. Do you give permission for Marlborough Tour Company to conduct a police check on you? Yes No Do you have a NZ Driver's Licence? Yes No What is your current notice period? What are your salary expectations? By ticking yes on this Employment Application Form, you are confirming that all the information you have provided to us is completely accurate. You also agree that if you are employed in this position based on the information you provided and it is later discovered that you misled us or any information was not accurate, that your employment many be terminated summarily. Yes
