Employment Application Form
Personal Information
Medical
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. If Yes, give brief details:
Have you ever been diagnosed with/ and treated for occupational over-use syndrome or any other similar condition? If Yes, give brief details:
In your past employment have you been exposed to any of the following; noise, solvents, asbestos, skin irritants, heavy metals, infectious metals? If Yes, give brief details:
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).
Additional Information
Entitlement to work in NZ
TORO check authorisation