Full Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone *

Country

(###)

###

####

Available start date (Thinning Nov-Dec)

MM

DD

YYYY

Available to work until date

MM

DD

YYYY

Do you consent to Hoddys Fruit Co Ltd to conduct reference checks?

Yes

No

Referee Contact Details:

First Name

Last Name

Referee phone number

Country

(###)

###

####

1. Are you aware of any commitments which may prevent you attending work regularly? If yes, please describe:

Yes

No

2. Are you legally entitled to take up employment in NZ, and do you consent to an ID check to confirm this? (you must be a New Zealand citizen, NZ resident, Australian citizen, or hold a current work visa or permit) *

Yes

No

3. Have you been convicted of a criminal offence in the past 7 years or are you awaiting a criminal court hearing? If yes, please describe convictions and/or current charges:

Yes

No

4. This role may involve heavy lifting up to a weight of 18 kg’s. Do you expect to have any issues with this? If yes, please tell us why:

Yes

No

Have you ever suffered from a back injury or back strain?

Yes

No

Do you have any condition, injury or illness which may affect your physical ability to carry out the type of work you may undertake at Hoddys, e.g. tendonitis, repetitive strain injuries? If yes, please describe:

Yes

No

Do you have any condition that may affect your ability to work for long periods of time standing?

Yes

No

Are you taking any drugs or medication that could affect or impair your ability to carry out your work? If yes, please discuss this at your interview.

Yes

No

Are you allergic to, or have sensitivity to, any substances or insects, e.g. bee stings?

Yes

No

Do you have any serious medical condition that you are aware of, including asthma, heart or respiratory problems, hernia, hepatitis, epilepsy, skin diseases or high blood pressure?

Yes

No

Do you suffer from colour blindness? (All staff will be subject to a colour blindness test)

Yes

No

Have you previously made any ACC claim?

Yes

No

6. In order to provide a safe and healthy work environment, Hoddys Fruit Co Ltd has a Drug and Alcohol Policy. Do you consent to a pre-employment drug test and to a drug and alcohol test during employment if requested?

Yes

No

7. Is there any information you may be aware of which you have not yet disclosed but which an employer might regard as being relevant to their decision to offer you employment? If yes, please detail:

Yes

No

8. Do you consent for Hoddys Fruit Co Ltd to hold the information collected with this application (i.e. application form, interview, referee checks, testing) and use it for the purpose of considering you for opportunities that may arise in the future? All information will be stored and used only as allowed by the Privacy Act 1993. *

Yes

No

Date

MM

DD

YYYY