EMPLOYMENT APPLICATION FORM

Transcription

1 EMPLOYMENT APPLICATION FORM The information you provide on this Employment Application form will be collected and held by HFH Limited and will be used for recruitment purposes only. This application is in no manner or form, a guarantee of employment. The information collected here is to assess your suitability for employment. Employment, if offered, is at the discretion of the company. If your application is successful, this information shall form part of your personnel file. If your application is unsuccessful, it will be held for three (3) months and will then be destroyed. NB: This is a physically demanding and overtime industry. Successful applicants must be prepared to work extended hours during the summer construction period. PERSONAL INFORMATION Position Applied For: Name: First: Last: Phone Numbers: Hm: Wk: Mb: Available to Start: DRIVING HISTORY Driver Licence : Version : (Please attach a photocopy of your driver s licence) Higgins Concrete Limited uses the NZ Transport Agency s Driver Check system to verify licence details. In signing this form you permit NZTA to release the information to Higgins. Class 1 Car Licence 4500kg or less Learner Restricted Full Class 2 Medium Rigid Vehicles 15001kg or less Learner Full Class 3 Medium Combinations 25001kg or less Learner Full Class 4 Heavy Rigid Vehicles 15000kg or more Learner Full Class 5 Heavy Combinations 15000kg or more Learner Full D F R T W Dangerous Goods Endorsement Forklift Endorsement Roller Endorsement Tracks Endorsement Wheels Endorsement

2 Please indicate the years and level of experience you have, in operating the following vehicles and/or machines. Digger: Forklift: Loader: Roller: Tractor: Truck: Truck & Trailer: Transporter: Other (please specify): In the past five (5) years, has your driver s licence at any time been cancelled or suspended? Have you incurred any speeding fines or other traffic infringements in the past three (3) years? Have you ever been involved in any vehicle crashes in the past three (3) years? Have you ever been disqualified from driving due to alcohol or drug-related offences? EDUCATION Please name Secondary School(s), University, Polytechnic or other Institutions Attended. Name of School From To

3 Please name any Qualifications gained (eg: School Certificate, University Entrance, NCEA). Please name any other Qualifications gained (eg: Polytechnic, University, Apprenticeship). Please describe the skills/training you hold which are relevant to the position applied for. EMPLOYMENT HISTORY Have you ever been employed by a Higgins Concrete or in this industry? Please detail your Employment history (starting with your current or most recent employment). Company Name: Position Held: Main Duties: Reason for Leaving: From: To: Company Name: Position Held: Main Duties: Reason for Leaving: From: To: Company Name: Position Held: Main Duties: Reason for Leaving: From: To:

4 HEALTH Have you ever suffered from vision impairment? (eg: use of contact lenses, glasses for driving) Have you ever suffered from back/shoulder pain and/or injury? Have you ever suffered from any overuse injuries? Are you allergic to, or have sensitivity to any insect, substances or chemicals? Do you suffer from epilepsy/seizures? Have you ever suffered from hearing/ear problems? Migraines/Headaches Diabetes/Thyroid disease Asthma/Bronchitis/Tuberculosis/Lung Disease Raised Blood Pressure Bone Disease/injury Stress related illness Skin Problems / Dermatitis Muscular Pain/Tendon Injury Do you have, or have you ever had any medical conditions, injury or injuries, which may affect you in the performance of any of the essential tasks and responsibilities of the position you are applying for? Please give details of all previous work and non-work accidents and state whether Accident Compensation was paid. Applicants will, during the pre-employment process, be required to have a health assessment to consider their suitability to carry out the tasks required of them for the type(s) of employment they are interested in. HFHL, Prenters Redimix Concrete, Limited is committed to providing a drug free workplace, and as such, applicants will be required to pass a drug and alcohol test prior to employment.

5 GENERAL Are you legally entitled to work in New Zealand? Please select the option that applies to you. New Zealand Citizen New Zealand Resident Work Visa/Permit Expires: Evidence of eligibility for employment in New Zealand may be required prior to any employment offer. Are you prepared to work overtime? Have you ever brought a personal grievance against a prior Employer? Are you awaiting the hearing of charges in any Civil or Criminal Court of Law? If yes, further information relevant to potential employment may be sought at any subsequent interview. Have you ever been charged with or convicted of a criminal offence either in New Zealand or overseas that is not concealed under the Clean Slate legislation? REFEREES Please give details of any work related referees that you authorise us to contact. Name & Job Title Company Contact Number Position of Referee (In relation to you) Name & Job Title Company Contact Number Position of Referee (In relation to you) DECLARATION Please read carefully and sign I authorise Higgins HFH Limited to obtain information from the above nominated referees concerning my suitability for employment and release such person from liability from any claims which may arise from the provision of such information. I further declare that the information I have provided in this Application Form, (including what is in my Curriculum Vitae where provided), is correct. I understand that should I be successful in my application, falsification or deliberately misleading information or suppression of information will be grounds for instant dismissal. Signature: Date: Additional Information Please attach any additional information, which would assist your application. Please provide only copies of documents as it is not our policy to return CV s. Please be aware that we may need to sight original documents prior to employment being offered.

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