ࡱ> .0)*+,-q` bjbjqPqP 4T::'AJL L L ` D;D;D;8|;=T` #~> H( I I IJQ_Uj|l|l|l|l|l|l|h'll|qL ZJ"JZZl| I Ic}cccZR IL Ij|cZj|ccnt* "L v I> `qgD;i[u x}0#~uK\H@vv"L vKW#XcX|9YKWKWKWl|l|c^KWKWKW#~ZZZZ` ` ` 1D;` ` ` D;` ` `  INCLUDEPICTURE "C:\\Documents and Settings\\LizW\\Local Settings\\Temporary Internet Files\\OLK28\\logo_bw.jpg" \* MERGEFORMAT  270 Neilson Street, Onehunga, Auckland P O Box 91 147, Auckland Telephone: (09) 634 3790 Facsimile: (09) 634 3791  HYPERLINK "http://www.spectrumcare.org.nz" www.spectrumcare.org.nz  APPLICATION FOR EMPLOYMENT CONFIDENTIAL To be completed personally by Applicant in full Please send with CV to Human Resources, PO BOX 91 147, Auckland. Spectrum Care Trust is an Equal Opportunity Employer. Completion of this form does not indicate that there is any obligation on Spectrum Care Trust to engage the applicant in employment. The information below is provided in accordance with the Privacy Act 1993. The information on this application is collected for the purpose of assessing your suitability for employment in the position applied for which may include subsequent changes in employment with Spectrum Care Trust. If successful, this information will form part of Spectrum Care Trusts human resource records. Unsuccessful applications will be confidentially destroyed by Spectrum Care after 12 months unless alternative instructions are received from the applicant. Applications that could be suitable for another position may be reviewed within the 12 months and statistical information will be retained. You are entitled to access or correct your human resource records or application forms upon request to the Human Resources Department. You will not be able to access evaluative material (such as verbal references, psychometric assessments, interview evaluation forms, etc.) unless written releases are obtained by the applicable third party and/or Spectrum Care Trust. IMPORTANT HOW TO USE THIS FORM This form is designed to be completed electronically. Please do not post or fax it to us once completed please send to:  HYPERLINK "mailto:jobs@spectrumcare.org.nz" jobs@spectrumcare.org.nz The grey areas are the parts of the form you can modify and fill-in. To enter text, position the cursor in the grey text area (they look like this:  FORMTEXT      ) by clicking on it with your mouse. Text areas will expand to fit your text unless only a certain number of characters (usually numbers) are required. There are also drop-downs that let you choose from a number of options ( FORMDROPDOWN ) and checkboxes ( FORMCHECKBOX ). Simply click on a drop-down to activate it and choose, then click on the option you wish to select. To check a box, just click it. If you check a box in error, click it again to uncheck it. APPLICANT TO COMPLETE In what location are you seeking employment?  FORMTEXT       e.g Mangere, Henderson Position applied for:  FORMTEXT       FT  FORMCHECKBOX  PT  FORMCHECKBOX  Cas  FORMCHECKBOX  Eg. Community Support Worker,/House Leader; casual/part-time/full-time How did you hear/learn about this vacancy?  FORMTEXT       Eg. Local newspaper (please name), internal vacancy, word of mouth Preferred Title:  FORMTEXT       Given Names:  FORMTEXT       Preferred Name:  FORMTEXT       Family Name:  FORMTEXT       Address:  FORMTEXT       Telephone Number: Home:  FORMTEXT       Work:  FORMTEXT       Mobile:  FORMTEXT       Email:  FORMTEXT       Are you entitled to work in New Zealand?  FORMDROPDOWN  RIGHT TO WORK (please tick relevant boxes) NZ NZ Permanent Work Permit Work Visa Student Visa Citizen Resident exp  FORMTEXT   / FORMTEXT   / FORMTEXT    exp  FORMTEXT   / FORMTEXT   / FORMTEXT    exp  FORMTEXT   / FORMTEXT   / FORMTEXT     FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  (if yes, you must be able to provide original documents on request eg. Passport, Work Visa, Birth Certificate etc) EDUCATIONAL ACHIEVEMENTS Please state your highest year completed or qualification gained Relevant Qualifications GainedSubject(s) if appropriate Secondary / School  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Tertiary  FORMTEXT       FORMTEXT      e.g. Technical Institute FORMTEXT       FORMTEXT      University FORMTEXT       FORMTEXT      Vocational FORMTEXT       FORMTEXT      i.e. Other  FORMTEXT       FORMTEXT      Training institutions  FORMTEXT       FORMTEXT       Other Relevant Skills and Experience:  FORMTEXT       Can you hold an everyday conversation in English?  FORMDROPDOWN  Can you hold an everyday conversation in a language other than English?  FORMDROPDOWN  (If yes, please give details:  FORMTEXT      ) PRESENT OR MOST RECENT POSITION Date From:  FORMTEXT       To:  FORMTEXT       Employer (name):  FORMTEXT       Position held: FORMTEXT       Description of Duties:  FORMTEXT       Number of hours worked per week:  FORMTEXT       Reason for leaving:  FORMTEXT       For the purpose of compliance with the Privacy Act 1993, do you consent to Spectrum Care Trust contacting your present employer for the purpose of reference checking?  FORMDROPDOWN  EMPLOYMENT HISTORY 1. Previous employer s name:  FORMTEXT       Date From:  FORMTEXT       To:  FORMTEXT       Position held:  FORMTEXT       Description of Duties:  FORMTEXT       Number of hours worked per week: FORMTEXT       Reason for leaving:  FORMTEXT       Previous employers name:  FORMTEXT       Date From:  FORMTEXT       To:  FORMTEXT       Position held:  FORMTEXT       Description of Duties:  FORMTEXT       Number of hours worked per week:  FORMTEXT       Reason for leaving:  FORMTEXT       Previous employers name:  FORMTEXT       Date From:  FORMTEXT       To:  FORMTEXT       Position held:  FORMTEXT       Description of Duties:  FORMTEXT       Number of hours worked per week:  FORMTEXT       Reason for leaving:  FORMTEXT       Previous employers name:  FORMTEXT       Date From:  FORMTEXT       To:  FORMTEXT       Position held:  FORMTEXT       Description of Duties:  FORMTEXT       Number of hours worked per week:  FORMTEXT       Reason for leaving:  FORMTEXT       REFEREES (Minimum of 2 required, preferably from someone you reported to e.g. Supervisor, Team Leader or Manager). Please ensure daytime contact details are specified. Name of referee:  FORMTEXT       Position:  FORMTEXT       Name of company where you worked for referee  FORMTEXT       Current contact details of referee: Telephone: FORMTEXT       Mobile:  FORMTEXT       Name of referee:  FORMTEXT       Position:  FORMTEXT       Name of company where you worked for referee  FORMTEXT       Current contact details of referee: Telephone:  FORMTEXT       Mobile:  FORMTEXT       In terms of the Privacy Act, 1993, I consent to Spectrum Care Trust seeking verbal or written information on a confidential basis about me from representatives of my previous employers and/or referees, and authorise the information sought to be released by them to Spectrum Care Trust, for the purposes of ascertaining my suitability for the position I am applying for. I understand that the information received by Spectrum Care Trust is supplied in confidence as evaluative material and will not be disclosed to me. Signature:  FORMTEXT       Date:  FORMTEXT       Please print name if submitting electronically TRAINING HISTORY Please detail any training (in-house or courses) that may be relevant to the position being applied for. Please attach proof of completion if available. Course Date/Year of completion Details of Training FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Have you completed any First Aid training?  FORMDROPDOWN  If yes, please indicate course name(s) and date of completion:  FORMTEXT       (Please attach proof of completion if available) Please indicate any licences, registration or professional memberships held:  FORMTEXT       HEALTH QUESTIONNAIRE (Please read the job description before answering the following questions) Have you previously suffered an injury an injury or illness which may place you at increased risk of harm at work?  FORMDROPDOWN  Some examples are as follows: Back Injury / Back Strain Overuse Injuries, gradual process injuries such as RSI / OOS Allergies (Specific to the role of Community Support Worker or House Leader - some duties include providing day to day hygiene care for the home. Some of the substances used would be dishwashing detergents, washing powder etc). Do you have any allergies to these substances? If Yes, please detail condition (include date of injury) as well as what, if any, support needs you have and/or what equipment or workplace alterations may be required:  FORMTEXT       This question is being asked so that we (the employer), comply with our 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 made subject to your obtaining a full medical clearance (by completion of medical examination) to assess your fitness for the job for which you are applying. If I am offered employment, I consent to Spectrum Care Trust 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. Signature:  FORMTEXT       Date:  FORMTEXT       Please print name if submitting electronicallyI consent to Spectrum Care Trust retaining the information contained in this questionnaire for the purposes of considering my suitability for any other position which may arise in the service in the future.  FORMDROPDOWN   GENERAL Have you ever worked for Spectrum Care Trust before?  FORMDROPDOWN  If yes, where and when?  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d$X&`#$/If]^d$X&`#$/If]GGGH H HHH2H4H6H@HBHDHfHHHHԿxjYK:.hBOJQJ^JaJ hhBCJOJQJ^JaJhCJOJQJ^JaJ hhCJOJQJ^JaJhBCJOJQJ^JaJ5j2?h-hfu5CJOJQJU\^JaJ hB5CJOJQJ\^JaJ4jh-5CJOJQJU\^JaJmHnHu)jh-5CJOJQJU\^JaJ5j>h-hfu5CJOJQJU\^JaJ h-5CJOJQJ\^JaJGDHHHrJtJvJ~JJJcVVV rd]^rAkd@$$Ifl4/&& 6`X&4 laf4Akd?$$Ifl4/&& 6`X&4 laf4 d$X&`#$/If] HJNJPJlJnJpJtJvJ~JJJJJJJJoaSE7hXUCJOJQJ^JaJhXUCJOJQJ^JaJhBCJOJQJ^JaJhBCJOJQJ^JaJ?hB5CJOJQJ^JaJehfHq r hB5CJOJQJ\^JaJheCJOJQJ^JaJhBOJQJ^JaJ/j@h[hfuCJOJQJU^JaJ#jh[CJOJQJU^JaJh[CJOJQJ^JaJhBCJOJQJ^JaJJJJJKKKjj`kdjC$$Ifl]R&(0(64 la $If]gd2  &$If]gd= ]^gdXU ]^ JJJ K K\K^KzK|K~KKKKKKKKKKKL:өᛉqYHFU h'hXUCJOJQJ^JaJ.jh%CJOJQJU^JaJmHnHu/jAh%hfuCJOJQJU^JaJ#jh%CJOJQJU^JaJh%CJOJQJ^JaJ/j"Ah=hfuCJOJQJU^JaJ#jh=CJOJQJU^JaJh=CJOJQJ^JaJhXUCJOJQJ^JaJ h'ohXUCJOJQJ^JaJe secondary employment?  FORMDROPDOWN  If yes, please give details:  FORMTEXT        Do you have a current driver s licence?  FORMDROPDOWN  If yes, what class?  FORMTEXT       Licence Number:  FORMTEXT       Do you have any demerit points or endorsements?  FORMDROPDOWN  If yes, please detail:  FORMTEXT       Driver check is a secure internet site set up by the Land Transport Safety Authority (LTSA). It allows Spectrum Care to check that only licensed drivers are driving company vehicles. In terms of the Privacy Act 1993, I consent to Spectrum Care seeking information about my licence class, endorsement, conditions and status from the internet site, Driver Check. I authorise the information sought to be release to Spectrum Care on a periodic basis (should I appointed), for the purposes of checking that I am a licensed driver which is a prerequisite for my appointment and ongoing employment with Spectrum Care. Signature:  FORMTEXT       Date:  FORMTEXT       Spectrum Cate Trust provides 24 hour coverage, are you prepared to work a variety of shifts?  FORMDROPDOWN  Have you worked shifts before?  FORMDROPDOWN  Criminal / traffic convictions: Please read carefully and answer question 1 or 2: Answer question 1 only if you are applying for employment that would not involve the care of children or young persons. Do you have any criminal convictions that are not concealed under the Criminal Records (Clean Slate) Act 2004 (see the note1 next page for more information about the Act)?  FORMDROPDOWN  If yes, please detail stating the year(s) and nature of the conviction(s)  FORMTEXT       Do you have any traffic-related convictions, not including any concealed under the Criminal Records (Clean Slate) Act 2004?  FORMDROPDOWN  If yes, please detail stating the year(s) and nature of the conviction(s)  FORMTEXT       Answer question 2 only if you are applying for employment that would involve the care of children or young persons. If you are applying for a job working with children or young persons, Spectrum Care is entitled to seek information concerning all criminal and traffic convictions, including those that would otherwise be eligible for concealment under the Criminal Records Act 2004. Do you have any criminal convictions? Please disclose any and all criminal convictions?  FORMDROPDOWN  If yes, please detail stating the year(s) and nature of the conviction(s)  FORMTEXT       Do you have any traffic-related convictions?  FORMDROPDOWN  If yes, please detail stating the year(s) and nature of the conviction(s)  FORMTEXT       Question 3 and 4 must be answered by all applicants Are you awaiting the hearing of any criminal charges?  FORMDROPDOWN  If yes, please detail  FORMTEXT       Should your application be successful, you will be asked to complete a form authorising the Police to release this information to Spectrum Care. Are you prepared to request that any information held by the NZ Police about you, including criminal and traffic records not otherwise eligible for concealment under the Criminal Records Act be forwarded to Spectrum Care?  FORMDROPDOWN  Note 1: It is your responsibility to disclose all criminal and traffic records that are not eligible for concealment under the Criminal Records Act 2004. If you are not sure whether your records are covered by this scheme, you must contact the Ministry of Justice, or refer to their website  HYPERLINK "http://www.justice.govt.nz/privacy/clean-slate.html" www.justice.govt.nz/privacy/clean-slate.html), for further information.  DECLARATION I declare that to the best of my knowledge the information provided in this application (and the attached Curriculum Vitae) is complete and correct. I understand that if any false or deliberately misleading information is supplied, or material information is suppressed, it may result in my not being offered the position applied for, or if I have already been employed it may result in my employment being terminated. I also understand that any false information given in relation to my medical history with regards to gradual 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 check to the satisfaction of Spectrum Care Trust. For example, should there be convictions of a serious nature such as those involving violence or dishonesty, this may lead Spectrum Care to terminate my employment. I also understand that if I am applying for work within Spectrum Care s Child Youth and Respite Service, any progress towards and/or any offer of employment, if made, is conditional on the return of a compulsory CYFS screening check to the satisfaction of CYFS and Spectrum Care Trust Until then, my employment will be provisional only. Should Spectrum Care receive an unsatisfactory New Zealand Police Check (and CYFS form if required), the appropriate policy and procedure will be followed. If this occurs, I understand I will not become a permanent employee until such time as Spectrum Care has confirmed to me, in writing, that it is satisfied with the New Zealand Police Check (and CYFS form if required), or otherwise. Please print your name:  FORMTEXT       Signature of Applicant: FORMTEXT       Please print name if submitting electronically Date:  FORMTEXT           Document TypeFORMIssuedJanuary 2008Manual/ TitleService/Human ResourcesVersion StatusVersion 14OwnerHR ManagerReview DateJanuary 2010Document Control ReferenceAD-2.6.11FaAuthorisationSimon Dunn FILENAME \p Q:\Forms\HR\Current\ApplicationForEmployment Form Version 14.doc Page  PAGE 3 of 7 :FHdfhZfhϷݩqYH:hXUCJOJQJ^JaJ hbehXUCJOJQJ^JaJ.jh%CJOJQJU^JaJmHnHu/jBh%hfuCJOJQJU^JaJh%CJOJQJ^JaJ#jh%CJOJQJU^JaJhXUCJOJQJ^JaJ/jFBh=h=CJOJQJU^JaJh=CJOJQJ^JaJ#jh=CJOJQJU^JaJ hXU5CJOJQJ\^JaJ\^rtvǹwǹ_wQ9/jEh=h=CJOJQJU^JaJh=CJOJQJ^JaJ/jEh%hfuCJOJQJU^JaJ.jh%CJOJQJU^JaJmHnHu/jDh%hfuCJOJQJU^JaJ#jh%CJOJQJU^JaJh%CJOJQJ^JaJhXUCJOJQJ^JaJ#jh=CJOJQJU^JaJ/jCh=h=CJOJQJU^JaJtvL:<>o`kdG$$Ifl]R&(0(64 la &$If]gd # $If]gd2  &$If]gd% LNbdfprtvbdxz|ѿѧ~~l^Fl/jFh #hfuCJOJQJU^JaJh #CJOJQJ^JaJ#jh #CJOJQJU^JaJ h'hXUCJOJQJ^JaJ.jh%CJOJQJU^JaJmHnHu/j6Fh%hfuCJOJQJU^JaJ#jh%CJOJQJU^JaJh%CJOJQJ^JaJhXUCJOJQJ^JaJ#jh=CJOJQJU^JaJ|(*,68:<>,.0ȺȢֺqcKqqc/jHh=h[CJOJQJU^JaJh[CJOJQJ^JaJ#jh[CJOJQJU^JaJhXUCJOJQJ^JaJ hbehXUCJOJQJ^JaJ/j"Gh #hfuCJOJQJU^JaJhXUCJOJQJ^JaJh #CJOJQJ^JaJ#jh #CJOJQJU^JaJ.jh #CJOJQJU^JaJmHnHu24RDF~pp$If]^gd2  & F $If]gd2 `kdxI$$Ifl]R&(0(64 la $If]gd2 NRDF",4<ǶsǶaPBPhXUCJOJQJ^JaJ hb}hXUCJOJQJ^JaJ#h'ohXU>*CJOJQJ^JaJ&hlhXU5>*CJOJQJ^JaJhXU5CJOJQJ^JaJ#hlhXU5CJOJQJ^JaJhXUCJOJQJ^JaJ hbehXUCJOJQJ^JaJhXUCJOJQJ^JaJ#jh[CJOJQJU^JaJ/jHh=h[CJOJQJU^JaJ<>R~weW?e/jJh,VhfuCJOJQJU^JaJh,VCJOJQJ^JaJ#jh,VCJOJQJU^JaJ hb}hXUCJOJQJ^JaJ/jIh=hPCJOJQJU^JaJ#jhPCJOJQJU^JaJhXUCJOJQJ^JaJhPCJOJQJ^JaJhXUCJOJQJ^JaJ hb}hXUCJOJQJ^JaJ#h'ohXUCJH*OJQJ^JaJ vnprȷxfNfx6/jKh,VhfuCJOJQJU^JaJ/j Kh=hPCJOJQJU^JaJ#jhPCJOJQJU^JaJhXUCJOJQJ^JaJhPCJOJQJ^JaJ#h,!_hXU>*CJOJQJ^JaJ hlhXUCJOJQJ^JaJ hvhXUCJOJQJ^JaJh,VCJOJQJ^JaJ#jh,VCJOJQJU^JaJ.jh,VCJOJQJU^JaJmHnHudp4dh$If]^gd2 $If]^gd0~U$If]^gd2  & F $If]gd2 $If]gd2 $If]^gd2 $If]gd2 $If]gd0~U&LNPlnpѽѬ{j{\J\2J\/jDLh=h0~UCJOJQJU^JaJ#jh0~UCJOJQJU^JaJh0~UCJOJQJ^JaJ hvhXUCJOJQJ^JaJhXUCJOJQJ^JaJ#h,!_hXU>*CJOJQJ^JaJ hlhXUCJOJQJ^JaJ hbehXUCJOJQJ^JaJ&hbehXU5>*CJOJQJ^JaJhXUCJOJQJ^JaJh,VCJOJQJ^JaJ#jh,VCJOJQJU^JaJ0246JLNXZ\^rraIr/jhMh=hi~CJOJQJU^JaJ hi~5CJOJQJ\^JaJ hlhXUCJOJQJ^JaJ.jhi~CJOJQJU^JaJmHnHu/jLhi~hfuCJOJQJU^JaJhi~CJOJQJ^JaJ#jhi~CJOJQJU^JaJh +CJOJQJ^JaJhXUCJOJQJ^JaJ h0~Uh0~UCJOJQJ^JaJ4\^BTVxz & F $If]gd2 $If]gd2 $If]gd2 dh$If]^gd2 $If]^gd2 $If]gd0~Udh$If]^gd2 Bսկ}oaOa7O/jNh=h9ZpCJOJQJU^JaJ#jh9ZpCJOJQJU^JaJh9ZpCJOJQJ^JaJhXUCJOJQJ^JaJhXU5CJOJQJ^JaJ#hbehXU5CJOJQJ^JaJ h,!_hXUCJOJQJ^JaJhi~CJOJQJ^JaJ.jhi~CJOJQJU^JaJmHnHu#jhi~CJOJQJU^JaJ/jNhi~hfuCJOJQJU^JaJ,.BDFPRTVXtxzJ\оoaPao? h=j5CJOJQJ\^JaJ h,!_hXUCJOJQJ^JaJhXUCJOJQJ^JaJ h,!_hXUCJOJQJ^JaJ.jh9ZpCJOJQJU^JaJmHnHu/j@TVXbdfөhWF hsahXUCJOJQJ^JaJ hsahsaCJOJQJ^JaJ/jShsahfuCJOJQJU^JaJ hsahsaCJOJQJ^JaJ.jhsaCJOJQJU^JaJmHnHu/jRhsahfuCJOJQJU^JaJ#jhsaCJOJQJU^JaJhsaCJOJQJ^JaJhXUCJOJQJ^JaJ hvhXUCJOJQJ^JaJ  df "<>өsk\s\sk\s\skh#O5CJOJQJ^JaJh#OCJaJh#OCJOJQJ^JaJh (jh (UhB.jhsaCJOJQJU^JaJmHnHu/jShsahfuCJOJQJU^JaJ#jhsaCJOJQJU^JaJhsaCJOJQJ^JaJhXUCJOJQJ^JaJ hXUhXUCJOJQJ^JaJ 2<Jd$If $$Ifa$ dflc]c]$If $$Ifa$kd T$$Ifl\ p\ 0@4 la "<ja[a[$If $$Ifa$kdT$$IflF\ p\ 0@4 la<>tlcZcT$If $$Ifa$ $$Ifa$kdU$$Ifl\ p\ 0@4 la>t^`np|~{fXPLFP>hBCJaJ h#OaJ*h (h#OCJaJh#OCJOJQJ^JaJ)hRCJOJQJ^JaJmHnHsH u)h#OCJOJQJ^JaJmHnHsH u"h#OCJOJQJ^JaJmH sH +jh#OCJOJQJU^JaJmH sH h#OCJaJh#OCJOJQJ^JaJh#O5CJOJQJ^JaJh#OCJOJQJ\^JaJ&h#O5B*CJOJQJ^JaJphlfddddddTd]^gdXU`kdVV$$Ifl\ p\ 0@4 la hB2&P :pSe. 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