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06 870 3026
Home/ Job Application
Home/ Job Application
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Job Application Form
Please complete the form below to submit your application. Fields marked with
*
are required.
First Name *
Last Name *
Position Applied For *
If Others, Please Specify*
Address *
Phone Number *
Email Address *
Gender *
Select Gender
Male
Female
Date of Birth *
Nationality *
Select a country
New Zealand
Australia
India
Philippines
Fiji
Samoa
Tonga
United Kingdom
South Africa
Other
Passport Number *
How did you hear about us? *
Internet / Google
Website
Work & Income
Friends
Facebook
Are You a New Zealand Citizen? *
Yes
No
If yes, please provide proof of NZ citizenship by uploading any Photo ID, Passport, Birth Certificate, Driver Licence, or 18+ Card.
Visa Type
Student
Open Work Visa
Resident
Other
NZ Citizen
Visa Expiry Date
Please upload a copy of your Visa, Passport, and other supporting documents.
Do You Have Any Conditions That May Affect Your Ability to Carry Out Functions for This Position? *
Yes
No
Are You at Present Receiving Any Medical Treatment and/or Taking Medication? *
Yes
No
Do You Consent to Undergo a Drug Test, Without Delay, Should It Be Required? *
Yes
No
Do You Have Any Criminal Convictions? *
Yes
No
If the Answer to Any of the Above Is Yes, Please Provide Details
Declaration *
I Declare That To The Best Of My Knowledge That The Answers In The Form Are Correct And I Understand That If Any False Or Deliberately Misleading Information Is Given, Or Any Material Fact Is Suppressed, That My Employment Will Be Terminated. I Understand That It Is Illegal To Use Someone Else's Identity Or ID Number And In Signing This I Confirm That The Above Information Belongs To Me Personally.
Date *
Signature *
Δ
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308 Albert Street, Hastings 4122
PO Box 527 Hastings 4175
06 870 3026
office@jcrservicesltd.co.nz
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