Confidential Employment Application Form

Position  Position applied for: Preferred office:  City  North Harbour Personal details Title: junk Please select Mr Mrs Ms Miss Dr First Name: Last Name: Address: Telephone: Mobile: Email: Are you, or have you been known by any other name(s)  yes  no If yes, please state name(s):  Employment Record/References   Current Employer: Employement period:  From   To Reason for leaving:   Past Employer: Employement period:  From   To Reason for leaving:   Past Employer: Employement period:  From   To Reason for leaving:   Past Employer: Employement period:  From   To Reason for leaving: Education Are you currently studying, if yes please state course: Secondary School Attended: Highest Qualification Attained:   year: Subjects: Tertiary Institute: Qualifications Gained:  year:  year:  year: Other courses completed: Reference Checks Referees will not be contacted without your prior knowledge.   Referees Please provide name, employer, position and phone number: Referee 1. Referee 2. Medical History Do you have any past or present medical condition or injury which could affect your ability to effectively carry out the functions of this position, or which could be aggravated or further contributed to be the tasks of the position applied for? Yes  no If yes please state:    Do you have any condition which could affect you while working in such a way as to put yourself or others at risk? Yes  no If yes please state:    General   Are you legally entitled to work in New Zealand? Yes  no   Have you ever been convicted of a criminal offence? Yes  no Are you awaiting the hearing of charges in a civil or criminal court of law? Yes  no If yes to either of the last two questions please give details: If yes to above please give details: Have you successfully completed your NZICA requirements? Yes  no If no, what papers/exams are to be completed? Salary Expectations: When could you start work at PKF Ross Melville? Please attach your CV here: Please attach your covering letter here: Send Application Please click below to send your application in confidence to our Practice Manager at PKF Ross Melville