• Position applied for *
• Title (Mr/Mrs/Ms/Miss/Dr) *
• Name * First Last
• Address *
• Home phone no *
• Mobile no *
• Email *
• Are you a New Zealand citizen? * Yes No
• If not, do you have resident status?
  Yes No
• Or, current work permit? Yes No
• Have you ever had a criminal conviction? * Yes No
• If yes, please detail:
• Have you ever received a police diversion for an offence? * Yes No
• If yes, please detail:
• Have you been convicted of a driving offence which resulted in temporary or permanent loss of license or imprisonment? * Yes No
• If yes, please detail:
• Are you awaiting sentencing/currently have charges pending? * Yes No
• If yes, please detail:
• In addition to other information provided, are there any other factors
  that we should know to assess your suitability for appointment and
  ability to do the job? * Yes No
• If yes, please elaborate:
• Have you had any injury or medical condition caused by gradual process, disease or infection, such as occupational overuse syndrome, stress or repetitive strain injuries, which the tasks of this job may aggravate or contribute to? * Yes No
• If yes, please detail:
• Do you have a current driver's license? * Yes No
• I declare all information relating to this application to be accurate and complete to the best of my knowledge. * Yes No
• Attach covering letter *
• Attach CV *