We do not accept online applications fax to (09) 302 1042 IBA / MARGARITA’S LTD
Application to be completed in your own handwriting
POSITION APPLIED FOR ________________________________________________________________
WORK REQUIRED full time? part time?
PLEASE CIRCLE DAYS AVAILABLE: Mon Tues Weds Thur Fri Sat Sun
PERSONAL INFORMATION
FULL NAME __________________________________________________________________________
ADDRESS __________________________________________________________________________
__________________________________________________________________________
Telephone _____________________________ Date of Birth _________________________
TRANSPORT Do you have your own transport? Yes No
HEALTH AND PHYSICAL PARTICULARS
Have you ever suffered any type of personal injury caused by work-related gradual process, disease, or infection?
Have you ever had any condition which is likely to contribute to a work-related gradual process injury, disease, or infection?
Have you ever had any serious illness, operation or accident, or condition which would hamper your work in this industry? Yes No
If yes, please specify:_______________________________________________________________________________________________
QUALIFICATION (Certificates to be supplied) ________________________________________________________________________
Managers Certificate: Yes No Food Hygiene Certificate: Yes No
HAVE YOU HAD ANY CRIMINAL CONVICTIONS IN THE LAST 5 YEARS? Do you have any criminal proceedings pending? IF YES, GIVE DETAILS____________________________________________________________________________________
ARE YOU LEGALLY ENTITLED TO WORK IN NEW ZEALAND? Yes No
CAN YOU SUPPLY THE NAMES AND TELEPHONE NUMBERS OF TWO REFEREES?
DO YOU SPEAK MORE THAN ONE LANGUAGE Yes No
IF YES, GIVE DETAILS: ______________________________________________________________________________________________
EMPLOYMENT RECORD
LAST OR PRESENT POSITION
EMPLOYER: __________________________________________________________________________
NATURE OF WORK: _________________________________ From______________To______________
REASON FOR LEAVING: _________________________________________________________________
PREVIOUS EMPLOYER: _________________________________________________________________
NATURE OF WORK: _________________________________ From______________To______________
REASON FOR LEAVING: _________________________________________________________________
PREVIOUS EMPLOYER: _________________________________________________________________
NATURE OF WORK: _________________________________ From______________To______________
REASON FOR LEAVING: _________________________________________________________________
APPLICANT’S DECLARATION
I certify that the above information is true and correct and authorise investigation of all information contained herein. I understand 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. I understand that if I accept employment I will be required to sign an Employment Agreement.
If appointed, I agree to observe the rules, policies and procedures issued by the premises.
Applicant’s signature: _____________________________________ Date: __________________________________________________
Thanks for your application - we will be in touch
