Careers Application for Employment "*" indicates required fields The completion of this form does not indicate that there is any obligation on the Company to engage the applicant. This information is collected for the purpose of assessing your suitability for employment which may include subsequent changes in employment with the Company.PositionWhat position are you applying for?*Please SelectLocation Your NameFirst Name:* Surname (Family Name)* Are you known by any other names?* Yes No What other names are you known by?* Contact DetailsContact Address*Email Address* Contact Phone* AgeHave you reached the current school leaving age (16 years)?* Yes No Legal Work StatusAre you legally entitled to work in New Zealand?* Yes No Please select the option for which you are legally entitled to work as* New Zealand citizen Permanent resident Holder of a current work visa Work visa expiry date* EducationName of secondary school(s) attended: Qualifications: (NCEA level) Trade or Professional Qualifications / ApprenticeshipsPlease give details including institute awarded fromLicensesDo you have a current First Aid Certificate?* Yes No Do you have a current Forklift Licence?* Yes No LanguagesCan you hold an everyday conversation in any language other than English?* Yes No Please list other languages spoken* Employment HistoryPresent, or most recent employerCompany Position Held Start Date Finish Date No. of hours worked per week Main DutiesReason for LeavingFor the purposes of compliance with the Privacy Act 2020, do you consent to the Company contacting your present employer for the purposes of reference checking?* Yes No Next Most Recent EmployerCompany Position Held Start Date Finish Date No. of hours worked per week Main DutiesReason for LeavingThis CompanyHave you ever worked for this Company or an associated company before?* Yes No Where and when?* Secondary WorkDo you have any secondary employment?* Yes No GeneralDo you know anyone who works for this company or in the same industry?* Yes No Who and where?* Do you have a current driver’s licence?* Yes No Please select the licence type:* Learners Restricted Full Do you have any demerit points or endorsements?* Yes No What transport arrangements do you have to attend work?* Are you prepared to work overtime / weekends when required?* Yes No Are you prepared to work shifts if required to do so?* Yes No Are you prepared to handle all products, materials or equipment used in the industry relevant to your role with appropriately supplied PPE? Yes No Criminal HistoryDo you have any criminal convictions, not including any concealed under the Clean Slate Act?* Yes No Please advise details* Are there any charges pending against you?* Yes No Please advise details* Do you consent to a pre-employment criminal convictions check?* Yes No Health & SafetyIt is important that you let us know of any relevant health issues or disabilities that you have that are relevant to the role you are applying for. If you are offered employment, the offer may be made subject to you obtaining a full medical clearance (by completion of medical examination) to assess your fitness for the job which you are applying for. Note: ALL employees are required to undertake a pre-employment drug and alcohol test and provide an ACC pre-employment check. Relevant disabilities or medical conditions and COVID-19 vaccination status The Human Rights Act 1993 defines disability as: "physical disability or impairment; physical illness; psychiatric illness; intellectual or psychological disability or impairment; the presence in the body of organism capable of causing illness; any other loss or abnormality of a body or mind function; and reliance on a guide dog, wheelchair or other remedial means".Do you have any disability, injury or medical condition that may affect your ability to fully, effectively and/or safely carry out the tasks and duties of the position for which you are applying, having regard to the tasks, responsibilities and duties described in the job description (and/or representations by Busck in this respect to date)?* Yes No Please provide details*Include services or facilities which would allow you to carry out the tasks and duties of the role applied for in a safe and satisfactory mannerDo you have, or have you had, any injury or medical condition caused by a gradual process, disease or infection which may be aggravated by the function and responsibilities of the position for which you are applying, and as it is described in the job description (and/or representations by Busck in this respect to date)?* Yes No Please provide details*Do you have any past or present injury for which you may or may not have claimed ACC (and/or other insurance cover), which may be aggravated by carrying out the duties of the position for which you are applying, and as it is described in the job description (and/or representations by Busck to date)?* Yes No Please provide details*Do you consent to a pre-employment medical check / baseline testing?* Yes No Do you consent to an ACC pre-employment check?* Yes No Do you consent to biological monitoring (drug testing) in accordance with the Health & Safety At Work Act 2015?* Yes No Is there any reason you cannot wear the following personal protective equipment (PPE)?Safety boots / shoes* Yes No Rubber boots* Yes No Breathing protection (mask)* Yes No PVC coats / trousers* Yes No Safety glasses* Yes No Gloves / hand protection* Yes No Covid-19While Busck are not vaccine mandated sites, some positions may require staff to be vaccinated either now or potentially in the future and we do take the health and safety of its working environment and staff seriously. We therefore ask that you advise us of your vaccination status.Have you received Covid-19 vaccinations?* Yes No Rather not say Please attach proof of vaccinationMax. file size: 25 MB.Date of first vaccination* dd/mm/yyDate of second vaccination dd/mm/yyDate of other vaccinations (boosters) dd/mm/yyRefereesPlease provide the name, address, email address, phone number for at least two current referees related to your past work.Referee 1Name Company: Their position in the Company in relation to you e.g. foreman / supervisor / managerTheir contact details Referee 2Name Company: Their position in the Company in relation to you e.g. foreman / supervisor / managerTheir contact details Reference Consent* I consentI consent to Busck seeking verbal and/or written information on a confidential basis about me from representatives of my previous employers and/or the referees listed above, and authorise the information sought to be released by them to Busck for the purposes of ascertaining my suitability for the position for which I am applying. I understand that the information received by the Company is supplied in confidence and evaluative material and will not be disclosed to me.Supporting DocumentsYour CVAccepted file types: docx, doc, pdf, Max. file size: 10 MB.Cover LetterAccepted file types: docx, doc, pdf, Max. file size: 10 MB.Privacy Act ConsentDo you consent to the Company retaining the information contained in this application form for the purposes of considering your suitability for any other position which may arise with this Company in the future?* Yes No DeclarationDeclaration* I declareI declare that, to the best of my knowledge, the information provided in this application and in any resume enclosed is accurate.I understand that if any false or misleading information is given, or any material fact suppressed (including medical), I will not be employed, or if I am employed, my employment may be terminated as failure to disclose information is treated as dishonesty and serious misconduct.I understand that any offer of employment I may receive will be conditional upon a negative drug and alcohol test being returned and a health test for establishing a base line where applicable.