Registration (Step1) - Personal Information

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Please note: (Y = Yes, N = No) and Fields marked with star ★ symbol are required fields.

Title           First Names:★
 		Surname:★
 		Category1:★
  Date of Birth:(dd/mm/yyyy)
 		Familiar Name / Nickname:★
 		Category2:★
  Job number:
If you are registering for a specific advertised position, please enter the job number here.
 
Address
Address:★
Road, Street etc:
Phone Numbers
Business:
  Box/Suburb:
   Fax:
  City:★
 PostCode:
 		Home:
  Country:★
   Cell:
  Other Contact:
   Email:★
 
Citizenship
If not NZ Citizen or Resident
    New Zealand or Australian Citizen Nationality
    Permanent NZ Resident Passport Issuing Country (or Country of Birth)★
    Hold NZ Work Permit Passport No.
    Require NZ Work Permit Work Permit No.
 		Expires (dd/mm/yyyy)
  How did you first hear about us?★
 		  Date of arrival in NZ (if overseas)
 
Work Sought
Y      N
Y      N
        Temporary/Contract       Permanent
        Full Time       Full Time
        Part Time       Part Time
        Have you Temped before?       Are you currently employed?
  Available to start (dd/mm/yyyy)
 		Position Sought
  For How Long?
 		Preferred Location
 
Hold NZ Drivers Licence
Normal Method of Transport to Work
  Full Own Car
  Restricted Public Transport
  Learner Other: 
  None Do you have any convictions against the law?
   
 
Industrial & Construction only
Y      N
        Steel capped work boots?
        Are the caps inside?
        Do you have any dependants?
        Do you smoke?
 
Health
  
  Have you had?
Y      N 		Do you suffer from?
Y      N
        Asthma       Earache, deafness
        Bronchitis       Skin infections
        Dermatitis or eczema       High blood pressure
        Hernia       Heart problems
        Back injury or strain       Diabetes
        Blackouts or seizures       Any allergies
        ACC compensation       Colour blindness
  If yes, dates of incidents       OOS (RSI)
  (dd/mm/yyyy)
  Details
  Y      N
        I have marked all the relevant boxes above which relate to my personal health
        Do you wear corrective lenses?
        Are you taking drugs or medicine?
  Details
  How many sick days have you taken in the past 12 months?
  0 - 5
  6 - 10
  11 - 15
  16 - 20
  Over 20 days
  Please give details of anything else which might affect your performance,
or which the Company should know about
 

    

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