CONFIDENTIAL APPLICATION FOR EMPLOYMENT

This information is being collected to enable Rangi Ruru Girls School to recruit the most suitable person for any available positions. It is therefore to be personally completed and signed by the applicant. All information provided will be treated in accordance with the Privacy Act 1993. The completed application will be received and held by the Principal and may be accessed and held by the Payroll Administrator and/or the Business Manager.

A current curriculum vitae may accompany this form outlining professional experience, personal strengths, interests, etc. and elaborating on information given on this form.

You should also include a letter outlining your reasons for applying for the position and what you think you can add to Rangi Ruru Girls School.

Position applied for ______________________________________________ Temporary Period available for temporary work ________________________ Permanent Are there any days you are unable to work? __________________ Please specify _____________________________________________

Personal details

Surname _________________ Preferred form of address Mr/Mrs/Ms/Miss/No title ______

First names _______________________ Email ____________________________

Address __________________________________________________________

Telephone number ____________________ (day) ____________________ (evening)

Emergency contact Name _________________________________ Telephone _________________

Address ________________________________________________________

Relationship to you _________________________________

Are you a New Zealand citizen? Yes No

If NO, do you have permanent residency? Yes No

If NO, do you have a work permit? Yes No

You may be required to provide your passport as evidence.

Educational details Dates Level achieved/ Secondary school/technical institute/university From To qualification obtained

Employment history

Present or most recent employer

Company name and address

_____________________________________________________________________

____________________________________Position held ________________________

Dates of employment From ___________________________ To ___________________

Describe duties of position ___________________________________________________

_____________________________________________________________________

Name of Supervisor/Manager _________________________________________________

Reason for leaving ________________________________________________________

Do you authorise Rangi Ruru to contact the employer listed above for the purposes of reference checking? Yes No

Previous employer Company name and address _________________________________________________ _____________________________________ Position held ______________________

Dates of employment From __________________________ To _____________________

Describe duties of position __________________________________________________

____________________________________________________________________

Name of Supervisor/Manager ________________________________________________

Reason for leaving _______________________________________________________ Do you authorise Rangi Ruru to contact the employer listed above for the purpose of reference checking? Yes No

Referees (excluding relatives and personal friends) Name Company Position Telephone

___________________________________________________________________

___________________________________________________________________

I authorise Rangi Ruru to contact the referees and employers listed above to obtain information about my character and previous employment, and authorize such persons to disclose personal information.

Signature __________________________________________ Date _______________ Health and physical record Do you have any medical condition or disability which may limit your ability to perform the job for which you are applying? Yes No If YES, what can be done to accommodate your limitation?

__________________________________________________________________

__________________________________________________________________

Have you ever had an injury or medical condition caused by gradual process, disease, or infection - for example; hearing loss, sensitivity to chemicals, occupational overuse injuries - which the tasks of this job may aggravate or contribute to? Yes No If YES, please detail

__________________________________________________________________

__________________________________________________________________

Extra-curricular experience/interests/community involvement

Criminal convictions Have you been convicted of any offences during the last ten years or are you currently awaiting the hearing of any charges? If YES, give details Yes No

__________________________________________________________________ Any appointment will be dependent on a satisfactory Police vet. Required under the Education Standards Act 2001

Payment of wages If selected, I agree to the payment of my wages by direct credit to a nominated bank account in accordance with my employment contract with Rangi Ruru Girls School.

Signature ____________________________

Declaration I declare that the information provided in this application and in the enclosed documentation is correct to the best of my knowledge. I understand that, if any false information is given or any material facts are suppressed, I may not be accepted or, if I am employed, I may be dismissed.

Applicants signature __________________________________________ Date ________