Additional Applicant Information Form

First Name

Surname

Home address

Phone Number

Have you already submitted an application on SEEK?

Yes

Ethnicity

Medical information

Are you fully vaccinated against Covid-19?

Yes

Do you currently have, or have you ever had, a medical condition caused by gradual process, or an injury, illness or disability that could reasonably be expected to affect your ability to carry out the work of the position applied for, or could reasonably be expected to be aggravated or contributed to by the work of the position applied for?

Yes

Have you ever suffered from any overuse injuries, eg. a repetitive strain injury or occupational overuse syndrome?

Yes

Are you taking any drugs or medicine that may affect your work performance?

Yes

Do you have any other condition, which may affect your ability to effectively carry out the functions and responsibilities of the position applied for?

Yes

Have you ever been convicted of any offence against the law, or do you have any criminal charges pending including traffic offences?

Yes

As this role includes working with vulnerable families, a police check will be required as part of the application process. Do you consent to provide supporting documents to undergo the Police Vetting process?

Yes

Anything else we should know?

Optional: Police vetting documents

If you like, you can speed up your application process by providing us with a completed Police Vetting form and two forms of legal identification (for example, a scan or photograph of your passport, driver's license, birth certificate, 18+ card etc.) Alternatively, you can email these documents separately to jobs@fsm.org.nz.

Supporting documents

Use the field below to upload the following documents: • CV • Cover letter • Completed police vetting form (optional) • Form of ID #1 (optional) • Form of ID #2 (optional)

File Upload

Drop your files here

Acknowledgement

I 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 also understand that any relevant false information given may result in my loss of entitlement for any compensation from ACC. I further accept that if I am successful in this application, that the information contained herein and any other information gathered in the course of my employment will be available to management. Any future changes as required to hours and days of work will be mutually agreed in writing between management and myself. I will provide evidence of qualifications, licences, identification and registration on request. I retain the right to inspect any such information held for the purposes of exercising my rights under the Privacy Act 1993. I have read and agree to the above statement.

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