APPLICATION FOR EMPLOYMENT

Families Wanted

Thank you for taking the time to complete this form. The application form is a source of information that will be used by Community Living to assist in considering your suitability to the position for which you are applying.

All information that you provide is strictly confidential and will not be available to any person not entitled to view it.

If successful, this application shall form part of Community Living’s personnel records. You are entitled to access this information upon request to the Human Resource Manager, 180 Collingwood Street, Hamilton, where the information is held.

Please complete the form and attach a copy of your Curriculum Vitae (CV), relevant qualifications and a covering letter. If you do not have a CV please complete the ‘Previous Employment’ section of this form.

Note: completion of this form does not indicate any obligation on Community Living to employ the applicant.

APPLICATION DETAILS
Date: 18/12/2017 Vacancy Number VAC389
Position applied for: Families Wanted
Service: Family Living Options
Where did you hear about this vacancy? *
Please specify name If heard through Staff Member or identify Other source:
PERSONAL DETAILS
Surname: * Given Name(s): *
Preferred Name if different from Given Name:
Street Address:*
Suburb:* Town/City:*
Primary Contact Phone No:* Other Phone No:
Email *
  (Please note, we will contact you via email, or your primary contact number)
LEGAL WORK STATUS

Are you legally entitled to work in NZ?

   
  A New Zealand Citizen
  A permanent resident
  A holder of a current work visa *
 

If you hold a current work visa when does it expire?  
LANGUAGE
Can you hold an everyday conversation in English? *  
Can you hold an everyday conversation in another language? Please specify: *  
EDUCATION AND QUALIFICATION DETAILS
Do you have any qualifications or certificates, or have you attended any courses? *
If yes, please detail:
Are you currently studying for any qualifications? *
If yes, please detail:
Please describe the skills, work experience and/or personal experience which are relevant to the position applied for including any experience with people who have a disability. If you need to, please feel free to attach any accompanying details to this application.
 
EMPLOYMENT HISTORY DETAILS
Please complete this section if you do not have a CV
Present or Most Recent Employer
Employer:
Address:
Position you held:
Start date: (MM/YYYY) End date: (MM/YYYY)
Reason for Leaving:
Next Most Recent Employer
Employer:
Address:
Position you held:
Start date: (MM/YYYY) End date: (MM/YYYY)
Reason for Leaving:
Next Most Recent Employer
Employer:
Address:
Position you held:
Start date: (MM/YYYY) End date: (MM/YYYY)
Reason for Leaving:
REFEREE DETAILS
Please provide names and accurate contact details of three people who have agreed to act as a referee and from whom we may request a reference report. At least two of these must be someone to whom you currently report to or have previously reported to (e.g. Supervisor, Team Leader or Manager).
Reference 1:
Name * Company: *
Day phone: Mobile phone:
Position of referee: * (e.g. Supervisor, Team Leader)
Reference 2:
Name * Company: *
Day phone: Mobile phone:
Position of referee: * (e.g. Supervisor, Team Leader)
Reference 3:
Name Company:
Day phone: Mobile phone:
Position of referee: (e.g. Supervisor, Team Leader)
For the purposes of compliance with the Privacy Act 1993, do you consent to Community Living contacting your current employer for the purposes of reference checking? *

For the purposes of compliance with the Privacy Act 1993, I consent to Community Living seeking verbal or written information on a confidential basis about me from any representatives of my previous employers and/or referees or any other relevant person and authorise the information sought to be released by them for the purposes of ascertaining my suitability for the position for which I am applying.

I understand that the information received by Community Living is supplied in confidence as evaluative material and will not be disclosed to me. *

CRIMINAL AND DRIVING HISTORY DETAILS
No applicant will be penalised for answering these questions honestly unless convictions are relevant to the safety and welfare of our clients.
Do you have any criminal convictions, including any concealed under the Criminal Records (Clean Slate) Act? *
If yes, please detail:
Are you awaiting the hearing of any charges in a civil or criminal court of law? *
If yes, please detail:

Note: It is your responsibility to disclose all criminal and traffic records. As an employee, you may have sole support of vulnerable people in their homes. For this reason, Community Living is exempt from the Clean Slates Act. Therefore, you must disclose all convictions that you may have. To learn more about the Clean Slate Act 2004 visit website www.justice.govt.nz.

DRIVERS LICENCE DETAILS
Do you have a full and current New Zealand drivers licence? *
If no, what kind of driver’s licence do you hold?
Drivers Licence Number:
If you hold an international drivers licence, what date did you arrive in New Zealand?
Are you proficient in driving: a manual vehicle *
an automatic vehicle *
a passenger van *
If required, do you agree to undertake driver training / assessment in the use of motor vehicles? *
Do you have any current demerit points or endorsements (within the last 2 years)? *
Have you ever been convicted of a driving related offence or disqualified from driving? *
If yes, please detail:
Do you have any traffic/driving cases pending? *
If yes, please detail:
Have you ever completed any driver education courses? *
If yes, please detail:
MEDICAL DETAILS
Do you have any health-related issues (including stress) that may impact on your ability to perform the tasks listed in the position description for the position you are applying for? *
If yes, please detail:
Have you previously suffered an injury which may place you at increased risk of harm at work by performing the requirements of the position description? (e.g. back injury, overuse injuries etc.) *
If yes, please detail:

This question is being asked to ensure Community Living complied with the obligations under the Health and Safety in Employment Act 1992, should you be employed by us.

If you are offered employment, the offer may be subject to you obtaining a full medical clearance to assess your fitness for the job for which you are applying.

If I am offered employment, I consent to Community Living obtaining information from third parties such as my GP, Specialist or ACC and to undergo a medical examination if required in order to ascertain my readiness for the position applied for. *
GENERAL DETAILS
Community Living provides 24-hour support in our residential type services which involves 24/7 rostered shifts.
Are you prepared to work shifts if required to do so?   *  
Have you worked shifts before? *  
Are you prepared to “sleepover” if required? *  
What type of employment are you looking for? *  

If part time, how many hours per week are you available to work? *  
Have you ever worked for Community Living before? *
If yes, where?
... and when?
Do you have a spouse, partner, relative or household member currently employed by Community Living or elsewhere in the disability industry? *
If yes, who?
What is your relationship with them?
Are you a member of any territorial force unit? *  
If so, have you completed whole time training?  
Do you consent to Community Living retaining the information contained in this application form for the purposes of considering your suitability for any other position that may arise in future? *
If your application is successful, when could you commence employment? *
UPLOAD YOUR DOCUMENTS
Supported file types: doc, docx, pdf, html, txt, jpeg, gif, png, tiff, bmp (Maximum file size is 4Mb)
Please upload your Resume/CV
Please upload your Cover Letter
Upload any other document you wish to submit
DECLARATION

By submitting this application, I declare that to the best of my knowledge the information supplied in this application and any CV attached is accurate. I understand that if any false or misleading information is given, or any material fact suppressed, I will not be employed, or if I am employed, my employment may be terminated.

I also understand that any false information given in relation to my medical history with regards to gradual process, disease, infection, impairment or injury that could affect my performance of duties may result in disciplinary action being taken, up to and including dismissal.

I further understand that any offer of employment, if made, is conditional on the return of a New Zealand Police vetting check that complies with the policy of Community Living and should there be convictions of a serious nature, my employment may be terminated, or any offer of employment withdrawn where employment has not already commenced.

I also understand that if I am applying for a position where I may work with or support people under the age of 17 years, any offer of employment, if made, is conditional on the return of a compulsory Child, Youth and Family Services (CYFS) screening check to the satisfaction of CYFS and Community Living.