Apply Job – countryroadorchards.co.nz

Thank you for applying for a position at Country Road Orchards

Gender

Male Female other

Position Applying For

Have you worked in a similar role before?

Yes No

Applying From (eg: country)

Do you have another job or personal circumstances that may interfere with your work here?

Yes No

Licence / Certificates / Qualifications

Driver Licence Forklift Licence First Aid Other

Do you have a medical, allergic or physical condition or injuries that may affect your ability to effectively carry out your duties?

Yes No

Are you currently receiving medical treatment or are you taking prescription medicine?

Yes No

Do you need to bring prescription medicine to work?

Yes No

Do you have a hearing disability?

Yes No

Have you ever suffered from a back injury?

Yes No

If you are offered employment, the offer may be subject to your obtaining a full medical clearance (by completion of medical examination) to assess your fitness for the job for which your are applying. Do you consent to undergo a medical examination if your are offered employment?

Yes No

Have you been diagnosed with any infectious disease or blood borne infections, or suffered persistent vomiting or diarrhea in the last 12 months, which we need to be aware of for food safety requirements? (refer Site Hygiene rules):

Yes No

Do you have any criminal convictions? Do not include any concealed under the Criminal Records (Clean Slate) Act 2004?

Yes No

Are there any charges pending against you?

Yes No

A. I consent to country orchards seeking information. on a confidential basis, about me from any previous employers or referees and authorise the information sought to be released for the purposes of ascertaining my suitability for the position for which I am applying. The information received by country orchards is supplied in confidence, and evaluative material will not be disclosed. I also consent to country orchards seeking information from Government Agencies or providing information to Government Agencies for employment-related purposes. B: For the purpose of providing a safe and healthy workplace, I acknowledge that I may be asked to undergo a pre-employment drug test. Refusal to undergo a drug test or a failed test will result in me not being employed. If I am employed before the results of my pre-employment drug test are available and/or receive a failed result, then my employment will be terminated immediately C: I understand that country orchards may take a digital photo of me for security and identification purposes. I understand that country orchards may also complete a security check with the New Zealand Police. I declare that all information supplied in this application is true and correct, and I understand that if any incorrect, misleading or suppressed information on this form or any other document provided to country orchards in any form whatsoever by any means may lead to disqualification or if appointed, to termination of employment.

Yes No

Application For Employment

Thank you for applying for a position at Country Road Orchards