Thank you for applying for a position with the Bay of Plenty Polytechnic.
The Bay of Plenty Polytechnic is committed to being an Equal Employment Opportunities (EEO) Employer and will ensure that
no-one is excluded from a job for which he or she is skilled and qualified by inappropriate processes and attitudes.
The information you provide in this application form will be used to help us assess your suitability for the position and for EEO
monitoring. It is important that the information you provide is accurate. If you do provide incorrect information we would
consider this to be grounds for dismissal in the event that your application is successful.
All information given to us will be treated confidentially and will only be released in accordance with the authorisations you
provide to us in this form.
If your application is successful, the information will become part of the Bay of Plenty Polytechnic's personnel records. You are entitled to
access the information upon request.
If your application is unsuccessful, the information will be destroyed after 6 months. All records are kept in a secure manner in
the Human Resources department until their destruction.
Please answer the following questions. The boxes marked with a * are compulsary |
|
Position Applied For:*
Group Leader - Electrical
Group Leader - Road Transport
IT Support Analyst (AV and VC Support) Fixed Term
Media and Marketing Administrator
Academic Staff Member - Electrotechnology (Tutor)
Other
|
Personal Information |
First Names* |
|
Last Name* |
|
| Address* |
|
Postal Code |
|
| Contact phone number (daytime)* |
|
Email* |
|
Where did you see the position advertised? |
|
| Reason for Applying for this Position | |
|
Please indicate which ethnic group you
identify with. *
* This information is only collected for the purpose of monitoring our employment practices in line with our EEO policy. |
|
Work Eligibility |
|
Are you a New Zealand citizen or a permanent resident of New Zealand?* |
YES
NO
|
If you are not a citizen or permanent resident of New Zealand, do you have the legal right to work in this country? 1
1 If you answer yes to the second question you will be required to produce your work permit if you attend an interview. |
YES
NO
|
If you are on a work permit, please specify the type of work permit you currently hold |
|
| If you are on a work permit, please specify the expiry date of your work permit |
|
Convictions |
|
Have you ever been convicted of an offence against the law in New Zealand or
another country (apart from parking offences?)*
* This question is subject to the provision of the Criminal Records (Clean Slate) Act 2004. This Act gives eligible individuals the
right, in some circumstances, to withhold information about their convictions. You can seek further information about this
Act from the Ministry of Justice; www.justice.govt.nz |
YES
NO
|
Do you have any criminal charges pending or under investigation?* |
YES
NO
|
If yes, please provide details. |
|
Do you agree to the Polytechnic accessing your record through the Department of Courts for any conviction for criminal activity?* |
YES
NO
|
Drivers Licence |
|
If the position for which you are applying requires that you operate a motor vehicle/s please state the type of vehicle/s. |
|
Do you have a current New Zealand Drivers Licence to operate that vehicle or vehicles? |
YES
NO
|
Drivers Licence Number |
|
Licence Classes |
|
If your application is successful do you agree to your name being registered with the
Land Transport Safety Authority driver check facility? |
YES
NO
|
Do you have any current demerit points relating to any of the licences listed above? |
YES
NO
|
If yes, please provide details: |
|
State of Health |
|
Do you have, or have you suffered from, a physical or mental impairment
or condition which may affect your ability to perform the tasks of this job?* |
YES
NO
|
If you have answered yes, please provide details: |
|
Do you have a medical condition that would require us to provide special facilities?* |
YES
NO
|
If you have answered yes, please specify the nature of the facilities required: |
|
Have you ever had an injury or medical condition caused by gradual process, disease or infection,
for example: hearing loss, sensitivity to chemicals, lung problems, repetitive strain injuries, back
injuries, which the tasks of this job may aggravate or contribute to?* |
YES
NO
|
If you have answered yes, please provide details: |
|
Medical Testing |
|
If you are shortlisted for the position do you agree to undergo a medical examination, which may
include a drug test, should the Polytechnic consider that such tests are relevant to the position?*
Any tests or examination would be conducted by a medical practitioner nominated by the Polytechnic. |
YES
NO
|
If yes, do you consent to the results of the tests and/or examination being disclosed/released
to the Polytechnic? |
YES
NO
|
| Education and Qualifications |
|
Please do not complete this section if your application is accompanied by a CV that contains all the information requested in
this section. |
|
Do you authorise the Bay of Plenty Polytechnic to contact these education institutions to
verify your stated qualifications or courses attended? |
YES
NO
|
Please describe the skills and experience, (e.g. computer skills, technical skills) you consider are relevant to your application
(excluding formal qualifications). |
|
| |
Have you ever worked for the Bay of Plenty Polytechnic or another tertiary
provider in New Zealand before? |
YES
NO
|
If so, where and when? |
|
| |
| Employment History |
|
Please do not complete this section if your application is accompanied by a CV that contains all the information requested in
this section. Please start with your present or most recent employment and work backwards: |
|
If selected for an interview would you like whanau or a support person to attend? |
YES
NO
|
If successful when could you commence employment with us? |
|
|
|
Referees
Please list two referees that the Bay of Plenty Polytechnic can approach now to discuss you and your ability to perform the role: |
|
| Additional Information
Please add here any information you wish to support your application: |
|
Attach Your CV/Resume: |
|
Declaration
I confirm that the information I have given is true and correct. I understand that if I have given incorrect or misleading
information, or if I have left out any important information, I may not be considered for appointment, or if appointed,
my employment may be terminated.
NOTE: You will be required to sign this application in the advent of an interview to verify that the information you have given is correct.
Please tick checkbox when ready to submit.
Thank you for your application. We will contact you shortly to advise you of the next steps in our recruitment process. |
|
