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Employment Application Form

Note: The completion of this form does not indicate that there is any obligation on the Company to engage the applicant.

Please fill in all required fields (*) for your application to be submitted.

Your Name

Your home address and telephone number

Date of Birth*

Contact person
(In the event of unforeseen circumstances at work we need someone to contact in any emergency - hence the necessity for this information)

Entitlement to work
Are you a New Zealand or Australian citizen?
YesNo

Are you legally entitled to work in New Zealand? (do you hold a New Zealand work permit covering the type of work applied for?)
YesNo

Qualifications
Do you have any qualifications, certificates, licences or attended any courses which you consider relevant to the position applied for (please give details).

Drivers licence
Do you have a current drivers licence?
YesNo

Do you have any demerit points or endorsements?
YesNo

If yes, please detail

I consent to Quigley Contracting Ltd obtaining information regarding my drivers licence details from the LTSA via their Driver Check Website. This consent is only applicable whilst employed by Quigley Contracting Ltd. Any information obtained shall be confidential to the management of Quigley Contracting Ltd.
YesNo

Previous work experience

Previous employment - Referees
Give name, address and telephone numbers of at least two referees.

I consent to the company seeking verbal or written information about me from representatives of my previous employers and referees and authorise the information sought to be released.
YesNo

Ability to do job applied for
What particular skills to you bring to this position?

Do you have other employment?
YesNo

If yes, please detail:

Do you have any personal responsibilities that may prevent you devoting your full time and attention to the position applied for? Eg. sport/volunteer work
YesNo

If yes, please explain:

Please state days/times when you would be unable to work:

Convictions - legal actions
Have you ever been convicted of any criminal offence or serious traffic offence, or are you currently awaiting trial on any criminal or civil matter?*
YesNo

If yes, please give details:

Please confirm if you consent to the Department of Courts or any other organisation releasing such information in support of this employment application.
YesNo

What housing would you need?
Own accommodationLiving in our accommodation complex with meals provided

What is your salary expectation?:

Existing and previous conditions
Do you have, or have you suffered from, any physical, medical, or other condition which may affect how you do the job you have applied for? Also list any allergies you have for emergency reasons.
YesNo

If the answer is yes, please give details:

Other interests
What are your interests outside work?

General
Please upload your C.V.*

If your application is accepted when could you commence employment?

Personal Information - The Privacy Act 1993
* The information supplied in this application is being collected by Quigley Contracting Ltd. The purpose for which the information is being collected is to determine your suitability for appointment for a particular position at Quigley Contracting Ltd including those positions for which you have expressed an interest. The information may be supplied to persons employed or engaged by Quigley Contracting Ltd to work on the interview/appointment process. The information supplied by you will be retained by Quigley Contracting Ltd if you are appointed to a position at Quigley Contracting Ltd. If you are not appointed to a position at Quigley Contracting Ltd, the information will be destroyed after a period of 12 months. All applications have the right in accordance with the Privacy Act to access and seek correction of personal information held in respect of them by Quigley Contracting Ltd.

I agree

Declaration and Authority
* I declare that I have completed all sections of this application truthfully. I understand that if I am successful in this application that providing incorrect, false or misleading information may be grounds for the termination of my employment.

I hereby authorize that the interview/appointment panel responsible for the position(s) I am applying for may contact the referees listed above, prior to the notification of appointment to confirm my suitability for the position and to also seek conformation of any details contained in my C.V.

I confirm that I have read and understand the section in this application headed "Personal Information - The Privacy Act 1993".

I agree

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