* Date of Application (dd/mm/yyyy)

Position Applied for

Your Name

Your home address and telephone number

Date of Birth*

Entitlement to work

Are you a New Zealand or Australian citizen?
YesNo

What country do you currently reside in?

Do you require a new work visa?
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, full, clean 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 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 hourly rate expectation?:

PRE-EMPLOYMENT MEDICAL QUESTIONNAIRE

Your answers to the following will be CONFIDENTIAL to Human Resources and will not be given to anyone else without your explicit permission. Our aim is to support and maintain the physical and mental health of all people at work.

The purpose of the assessment is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have applied for or place you at risk in the workplace. In the consultation with you, we may recommend adjustments or assistance as a result of this assessment to enable you to do the job.

Please provide detailed information below – failure to do so will delay your recruitment application.

Have you ever left or retired from a job due to medical reasons?
YesNo

Have you ever had any illness that may have been caused by or made worse by your work?
YesNo

Do you consider yourself to have a disability?
YesNo

If the answer is yes, do you feel that you need any adjustments or modifications to do the job for which you have applied, please give details:

Are you having any treatment or investigations of any kind now?
YesNo

Are you waiting for any treatment or investigations?
YesNo

Do you have any eyesight problems not corrected by glasses?
YesNo

Do you have any hearing problems not corrected with a hearing aid?
YesNo

Do you have any difficulty in standing, bending, lifting or any other movements?
YesNo

If the answer is yes, please give details:

Have you ever had any back, shoulder, arm, wrist, or neck pain lasting more than 3 days?
YesNo

If the answer is yes, please give details:

Have you ever had any mental illness or psychological problems, including depression, anxiety, schizophrenia, or self-harm?
YesNo

Do you have any digestive problems?
YesNo

Have you ever had any drug or alcohol related problems?
YesNo

Have you ever had seizure, epilepsy, blackouts, sudden unexplained dizziness, or loss of consciousness?
YesNo

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?
YesNo

If the answer is yes, please give details:

Please list any allergies you may have for emergency reasons.

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 2020

* 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 authorise 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 2020".

I agree