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

________________________

Are there any days you are unable to work? __________________

Permanent

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
Secondary school/technical institute/university

Dates
From

To

Level achieved/
qualification obtained

Employment history
Present or most recent employer
Company name and address

_____________________________________________________________________
____________________________________Position held ________________________
Dates of employment

From

Describe duties of position

___________________________ To ___________________

___________________________________________________

_____________________________________________________________________
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?
If YES, what can be done to accommodate your limitation?

Yes

No

__________________________________________________________________
__________________________________________________________________
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
If YES, please detail

No

__________________________________________________________________
__________________________________________________________________

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 ________