Application Form

Please complete the following form ensuring all required fields () are answered. Do include any information that could be relevant for the position you are applying for.


	POSITION APPLYING FOR:

	Personal Details
		Title:
		First Name:
		Last Name:
		Previous Last Name: (if applicable)
		Preferred Name:
		Phone Number:
		Alternative Phone Number:
		Email Address:	Set up a Hotmail account
		Street:
		Suburb:
		City:
		Country:
		Postal Address: (if different)
		Age Group
		Are you currently in New Zealand?	Yes No
		Are you currently registered with Work and Income NZ?	Yes No
		How did you hear about employment at Wai-West Horticulture Ltd?
		Please select your job type
		Availability? (if other please specify in comments box at bottom of form)
		Do you require accomodation on orchard?	Yes No
		Have you worked for Wai-West Horticulture Ltd before?	Yes No
		If yes please write approximate dates and the name of your previous supervisor / manager who should remember you:


	Employment Details
		Please give us details of your most recent employers:
		Employer 1:
		Employer Contact Number:
		Approx Dates Employed:
		Position Held:
		Reason for leaving:
		Employer 2:
		Employer Contact Number:
		Approx Dates Employed:
		Position Held:
		Reason for leaving:

		Do you agree to enquiries being made of your past employers?	Yes No

		Are you a New Zealand citizen/Permanent Resident?	Yes No

		If no, do you currently have a work permit?	Yes No
		If no, please contact admin@wai-west.co.nz for details on obtaining work permits or extending visa.	Expiry Date

		Do you suffer from an illness/disability which would be aggravated or made worse by performing the job you have applied for?	Yes No

		Are you on medication which would affect your performance in the job you have applied for?	Yes No

		Have you had an injury or medical condition caused by gradual process, disease, or infection - eg: hearing loss, sensitivity to chemicals, repetitive strain injury - which tasks of this job may aggravate or contribute to?	Yes No

		Have you had a ACC claim for any injury?	Yes No

		Have you had an injury, strain or pain of the finger / wrist / neck / shoulder / back?	Yes No

		Have you had a Hernia or suffer from Skin rashes, Dermatitis, Eczema, Asthma or Bronchitis?	Yes No

		If yes, please give details on all the above:


		Any other comments related to your application?


		If applicable, upload your curriculum vitae here: