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POSITION APPLIED FOR

Relief Customer Services Officer - Mount Maunganui Beachside Holiday Park

CONFIDENTIAL

Information collected on this application form is used to assess your suitability for employment within Tauranga City Council. Applicants must complete this form personally, answer all questions and accept the declaration. This application should be supported with a Curriculum Vitae and covering letter. The completion of this form does not indicate any obligation on Tauranga City Council to engage the applicant. If unsuccessful, your application, CV and all other supporting documentation will not be kept for longer than 6 months only before being destroyed.

PERSONAL DETAILS

Title :		MrMrsMissMs

Surname :		*
First Name :		*
Street Address :		*
Suburb :
City :		*
Post Code :		*
Country :		Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia (Local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Dem People's Republic Korea, Republic Of Kuwait Kyrgyzstan Lao People'S Dem Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Ant Illes New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent, The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia, S Sandwich Is. Spain Sri Lanka St. Helena St. Pierre And Miquelon Sudan Suriname Svalbard, Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic Of Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Is. Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Phone (day) : (numbers only)		*
Phone (evening) : (numbers only)
Mobile : (numbers only)
Email address :		* (Note: Email is our preferred method of communication)

LEGAL WORK STATUS

*Are you legally entitled to work in New Zealand?   Yes No

*If yes, are you a		New Zealand / Australian citizen
		permanent resident
or a		holder of a current work permit
		Expiry :  (dd/mm/yyyy)
*Are you an assisted immigrant under bond to the government or any other employer? Yes No

SKILLS/ATTRIBUTES

Please list your specific skills and attributes that are relevant to this position :

(Up to 500 Characters)

HOW DID YOU FIND OUT ABOUT THIS POSITION?

*So we are able to gauge which advertising medium is most successful, could you please indicate to us where you saw the advertisement for this position:

Tauranga City Council Website Newspaper LinkedIn Seek Other

MEDICAL

Declaration of a medical condition does not necessarily exclude employment opportunities within the Council. The following questions are to ensure you can safely carry out the duties of the position.

Please declare any health or physical matters which are relevant to your ability to perform in the intended role, and/or impairment which may be aggravated by activities in this position, e.g. back, hearing, eyesight or heart problems, or any physical injury.

(Up to 100 Characters)

*Have you had an injury or medical condition caused by gradual process, e.g. disease or infection. For example: hearing loss, sensitivity to chemicals, repetitive strain injuries, that may be aggravated or further contributed to by activities in this position?   Yes No     If yes, please detail :

(Up to 100 Characters)

CONVICTIONS AND PROCEEDINGS

*Do you have any previous, current or pending criminal convictions or charges in New Zealand or any other country?

This question is subject to the provision of the Criminal Records (Clean Slate) Act 2004. This Act gives eligible individuals the right, in some circumstances, to withhold information about their convictions. You can seek further information about this Act from the Ministry of Justice www.justice.govt.nz.

Yes No     If yes, please detail :

(Up to 100 Characters)

DRIVING

*Do you have a current full drivers licence?   Yes No     If yes, what class/es? Car Motorcycle HT (Truck) Bus Endorsement Other

*Do you have any demerit points or charges for driving offences (current or pending)?   Yes No     If yes, please detail :

(Up to 100 Characters)

GENERAL

*Do you have secondary employment? Yes No

If yes, please detail :

(Up to 100 Characters)

*Are you currently employed by Tauranga City Council? Yes No

If yes, please detail :

(Up to 100 Characters)

*Have you previously worked for Tauranga City Council?   Yes No     If yes, please detail :

(Up to 100 Characters)

*Do you have a spouse/partner/relative or household member currently employed by Tauranga City Council?   Yes No     If yes, please detail :

(Up to 100 Characters)

*Would any spouse/partner/relative who has a business relationship with Tauranga City Council create a conflict of interest if you are appointed?   Yes No     If yes, please detail :

(Up to 100 Characters)

*Have you entered into bankruptcy or any material accommodation with creditors?   Yes No     If yes, please detail :

(Up to 100 Characters)

COVERING LETTER

*Please attach covering letter :

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Maximum file size 10MB. The file must be in Word or PDF format. Please ensure characters such as ' " / \ and ` are not used in the filename.

CV

*Please attach CV :

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Maximum file size 10MB. The file must be in Word or PDF format. Please ensure characters such as ' " / \ and ` are not used in the filename.

DECLARATION

I declare as follows:

1.	All representations, whether oral or in writing, made by me in applying for this position about my qualifications and experience are true and correct and I have not deliberately failed to disclose any matter which may materially influence the Council's decision to employ me. I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I will not be accepted, or if I am employed, my employment will be terminated.
2.	I also understand that any false information given in relation to my medical history with regards to gradual process, disease or infection can result in my loss of entitlement for any compensation from ACC. I further understand that any offer of employment if made, is conditional on my obtaining a full medical clearance, if required, through the Tauranga City Council's pre-employment medical check by an approved practitioner.
3.	Should my application be successful, I give my consent to any vetting processes that Council undertakes which includes employer references and security checks such as (criminal, financial, drivers licence status, traffic infringements and dismissal register) and agree to co-operate in providing information to assist that vetting process.
4.	I further understand that should any offer of employment be made that this will be subject to satisfactory results being obtained from Tauranga City Council's pre-employment screening process. In the event that any results are deemed to be unsatisfactory to Tauranga City Council then any employment relationship will be terminated.
5.	I consent to the Tauranga City Council seeking verbal or written information on a confidential basis about me from the referees provided and I authorise the information sought to be released by them to the Tauranga City Council for the purposes of ascertaining my suitability for this position. I understand that the information received by Tauranga City Council is supplied in confidence as evaluative material and will not be disclosed to me.
6.	It is our standard practice to undertake pre-employment checks for all vacancies. I consent to Tauranga City Council undertaking pre-employment security checks which include, but are not limited to: NZ Criminal & Traffic Convictions Check (MOJ) Driving Licence Status & Traffic Infringement History Dismissal Register NZ Immigration Status Check (Visaview) NZ Highest Educational Check Financial Report (if relevant)
	I Agree  *

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