Application for employment Application to be completed by the applicant. Positions applied for Function Team Leader Function Staff Kitchen-hand Chef's assistant Product Chef Work required Casual Days available Monday - Day Monday - Evening Tuesday - Day Tuesday - Evening Wednesday - Day Wednesday - Evening Thursday - Day Thursday - Evening Friday - Day Friday - Evening Saturday - Day Saturday - Evening Sunday - Day Sunday - Evening Personal Information First Names Last Name Preferred Name Address Contact Phone Number Email address Date of Birth (optional) Next of Kin In case of emergency (medical or accident) who should we contact Name Phone number Do you hold a current driver's licence? Yes No Driver's Licence Class Full Restricted Learners Driver's Licence Number I consent to a driver's licence check Health and Physical Particulars Have you ever suffered any type of personal injury caused by a work-related gradual process, disease, or infection? No Yes Have you ever had any condition, which is likely to contribute to a work-related gradual process injury, disease, or infection? No Yes Have you ever had any serious illness, operation or accident, or condition, which would hamper your work in this position? No Yes If yes, please specify Qualifications Have you been charged with any offences in the last 5 years? No Yes If yes, please give details Do you have any legal proceedings pending? No Yes If yes, please give details Are you a New Zealand Citizen? Yes No Are you legally entitled to work in New Zealand? Yes No Do you hold a current work permit? Yes No If yes, when does it expire? Employment Record Last or Present Employment Position held Employer Nature of work Date held from Date held to (if position no-longer held) Reason for leaving (if position no-longer held) Previous Employment Employer Nature of work Date held from Date held to Employer Nature of work Date held from Date held to Can the above employers be contacted as referees? Yes No If no, please provide names and contact details of at least two referees one of which must have been an employer Please provide your CV Applicants Declaration I CERTIFY that the above information is true and correct and authorise investigation of all information contained herein for the purpose of ascertaining my suitability for employment, including conducting credit and criminal record checks through the appropriate authorities and contacting referees and previous employers. I understand that if I have given false or misleading information or if I have left out any important information, I may not be considered for the appointment. If I am appointed before any inaccuracies on this form are discovered, my employment may be terminated. I understand that in some situations, providing false information may amount to an offence under the Crimes Act. I understand that if I accept employment I will be required to sign an Employment Agreement. If appointed, I agree to observe all rules, policies and procedures issued by the establishment.