Employment Application

Physical, mental or health conditions

Do you suffer from any physical, mental or health condition likely to affect the full performance of your duties? This includes any current/previous ACC Claims within the last 2 years.

Occupational over-use syndrome

Have you ever been diagnosed with/ and treated for occupational over-use syndrome or any other similar condition?

Exposure to substances

In your past employment have you been exposed to any of the following; noise, solvents, asbestos, skin irritants, heavy metals, infectious metals?

Predisposition to any other conditions

Do you have a predisposition to any other condition that you are aware of, including but not limited to asthma, heart or respiratory problems, high blood pressure or communicable diseases (eg. HIV, Hepatitis).

Attach a CV below or provide details of your past 5 years work experience?

Note: Detail company name, position held and approx. start and finish dates, or attach CV in next field.

Attach CV*

Please upload your CV. This may be in plain text, pdf or Word document format. Any issues please contact Kyla Hughson during office hours 06 751 9221. If you do not have a CV please include past 5 years employment above.

Attach other relevant qualifications

Please upload any other relevant qualifications or certificates e.g. first aid certificates, approved/certified handlers certificate, forklift certificate. This may be in plain text, pdf or Word document format. Any issues please contact Kyla Hughson during office hours 06 751 9221.

Please either attach two work references or give names and contact numbers for two work referees

Other relevant experience

Comments

Any questions or comments you would like to have recorded.

Classes and endorsementsClass 1 - Car licenceClass 2 - Medium rigid vehicleClass 3 – Medium combinationClass 4 – Heavy rigidClass 5 – Heavy combinationW – WheelsT - TracksR - RollersF – ForkliftD – Dangerous GoodsP – Passenger Endorsement

Drivers licence - Front*

Please upload a copy of both the front and back of your drivers licence (use the field below if you have two separate files to upload) - If you do not hold a Drivers Licence please upload some form of ID. File must not exceed 8MB. If you are unable to upload using this webform, please email copy to admin@symonsgroup.co.nz or call Kyla Hughson on 06 751 9221.

Drivers licence - Back*

Licence validation check agreement*YesNo

I consent to Symons Group using TORO (Transport Organisation Register Online) through the New Zealand Transport Agency for the purposes of ensuring that I am fully licensed at all times and/or to monitor my licence status and activity.

1. I declare that the answers to the questions in the application are true and correct and I understand that the information requested within this application form is sought to establish my suitability for the position that I am applying and that if I do not provide such information then this application for employment may be rejected.

2. I note that any offer of employment does not constitute an employment agreement until a separate agreement has been evidenced in writing and signed by Symons Group and myself.

3. I am not aware of any personal circumstance, medical condition or disability that would limit my ability to adequately perform the role for which I seek appointment.

4. I accept that, should my application be successful, the foregoing information will form part of my contract of employment and falsification of any information is grounds for dismissal.

5. Writing your full name in the box below acknowledges you agree with the above declaration.

Signature*

Please type your full name as confirmation that the above information is correct.