Thank you for your interest in working at Longveld. Finding the best people to work in our team is very important to us - we look for top quality skills, team fit and a desire to really make a difference in the work we do. If you think you have the right mix of all of these things, then we'd like to hear from you!
The information in this application is collected for the purpose of assessing your suitability for employment with Longveld which may include subsequent changes in employment with the company. The completion of this form does not indicate that there is any obligation on Longveld to engage you. This information will form part of our personnel records which you are entitled to access on request to the HR Co-ordinator. If you have any enquiries, please contact our HR Co-ordinator, on +64 7 846 6901.
If yes, please provide brief details:
Please provide accurate names and contact details of two people who have agreed to act as your referee and from whom we may request a confidential reference.
Daytime phone :
Do you consent to the company seeking verbal or written information on a confidential basis about you from representatives of your previous employers and/or referees and authorise the information sought to be released by them to the company for the purpose of ascertaining youry suitability for the position you are applying for?Yes No
For the purposes of the Privacy Act 1993 do you consent to the company contacting your present employer for reference checking?Yes No
To meet the requirements of the Health and Safety in Employment Act, we are required to verify your fitness and suitability for the position you have applied for, so that you will not be harmed at work.
Please complete the following questionnaire, which may be forwarded to a Registered Medical Practitioner for advice. Additionally, you may be required to undergo a medical examination by a company nominated medical practitioner, as well as a drug and alcohol screening test. This examination will be used to verify that any pre existing conditions will not be aggravated, and that you are fit to carry out the work the position requires. A job may not be offered if you refuse to undergo an examination or a drug and alcohol screening test.
If you have answered "Yes" to any of the questions above, or have any pre existing condition (listed above or not) that may affect your ability to carry out the tasks associated with the position, please explain below:
Other entitlement? please specify:
Please type or paste your covering letter into the space provided below and attach an electronic version of your current Curriculum Vitae.
I (full name) declare that to the best of my knowledge the answers in this application are correct and I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I will not be accepted, or if I am employed, my employment will be terminated.
I give my permission for the company to conduct a criminal record check.
I also give my permission for the company to have access to, discuss and use the information arising from the criminal record check, medical questionnaire or subsequent medical examination.
Accept Declaration Yes No
153-157 Ellis Street
PO Box 5538, Frankton
Hamilton, New Zealand 3242
T +64 7 846 6901
F +64 7 846 2550