BULK CARGO CO-ORDINATOR

Job Application Form

Position applied for

Date

Personal Details

Surname

Forenames

Preferred name

Also known by any other name? (Please state)

Residential address

Email address *

Home Phone

Mobile

Date of Birth

Person to be contacted in case of emergency

Relationship

Address

Phone

Work/Legal Status

Are you legally entitled to work in New Zealand

If YES, please select

NZ Citizen
Permanent Resident
Work Permit*

*If on a WORK PERMIT, please provide permit type and expiry date:

Work permit type

Work permit expiry date

You will be required to product proof of eligibility

Education Qualifications

Education provider

Dates Attended From

Dates Attended To

Qualifications Obtained

Education provider

Dates Attended From

Dates Attended To

Qualifications Obtained

Education provider

Dates Attended From

Dates Attended To

Qualifications Obtained

Driving Skills

Do you hold a current drivers license

Expiry Date

Class(es)

Employment History

Please begin with you current or most recent employer (do not leave any details out)

Employer 1

Position held

From (include month and year)

To (include month and year)

Reason for leaving

Employer 2

Position held

From (include month and year)

To (include month and year)

Reason for leaving

Employer 3

Position held

From (include month and year)

To (include month and year)

Reason for leaving

Employer 4

Position held

From (include month and year)

To (include month and year)

Reason for leaving

Have you ever been dismissed, or resigned as an alternative to being dismissed in previous emplyment

If YES, please provide full details

Criminal History

Have you ever been convicted in a court in New Zealand or in any other country?

Have you ever been imprisoned in New Zealand or any other country?

Are you awaiting a hearing on any charges?

If YES to any of the above questions, please provide details of the convictions/allegations

Disabilities, Injuries, or medical Conditions

Do you have a disability or medical condition that may affect you're ability to carry out the tasks and responsibilities in the job description?

If YES please give details

Do you have, or have you had, any injury or medical condition which may be aggravated by the function and responsibilities of the job applied for?

If YES, please give details

Have suffered any injury to your neck, shoulders, or back?

Have you ever recieved ACC payments for any injury?

If YES to any of the above questions please give details

Please give any details about any other ailments or diseases which may affect your performance, or which the company should know about.

Are you willing to undergo a Pre-employment Medical and Drug and Alcohol Test paid for by the company?

Referess

Ideally all three people should be your current and/or previous managers, if required the third person could be a suitable alternative - e.g. character referee

Referee 1

Name of Referee

Referee's current position

Organisation

Your relationship to this referee (e.g. Referee was my supervisor)

Work Phone

Mobile Phone

Referee 2

Name of Referee

Referee's current position

Organisation

Your relationship to this referee (e.g. Referee was my supervisor)

Work Phone

Mobile Phone

Referee 3

Name of Referee

Referee's current position

Organisation

Your relationship to this referee (e.g. Referee was my supervisor)

Work Phone

Mobile Phone

Do you consent to South Port NZ Limited seeking verbal or written information on a confidential basis from the above referees?

All information recieved by the company is supplied in confidence and as evaluative material and will not be disclosed to you.

Upload your curriculum vitae

Upload a cover letter

Declaration & acknowledgement

I understand and acknowledge that this information is being collected by South Port to enable you to assess my suitability for this position and will be used for this purpose only. If I provide false or inaccurate information, this will be considered serious misconduct and may result in my dismissal (should I be employed).

I declare that to the best of my knowledge the information that I have provided is accurate and complete.

job application form

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Job Application Form

Personal Details

Work/Legal Status

Education Qualifications

Driving Skills

Employment History

Criminal History

Disabilities, Injuries, or medical Conditions

Referess

Referee 1

Referee 2

Referee 3

Declaration & acknowledgement