Application form for Employment –
New Zealand
Te Toi Tupu – Leading Learning Network
The information on this form is sought for the purpose of assessing your suitability for employment with Te
Toi Tupu – Leading Learning Network and will be retained, used and disclosed only in accordance with the
Privacy Act 1993. If you have any queries about this form please contact jobs@tetoitupu.org.
Personal details
Last name:
First name:
Maiden name /other name(s) known by:
Phone number (work):
Phone number (home):
Phone number (mobile):
Physical address:
(how long at this address)
Email address:
Position applied for:
Position reference number: (If applicable)
Availability to start / Notice period:
Salary expectation:
Do you have a current NZ Driver’s Licence?
Have you ever been disqualified
(If Yes, please give details)
Licence Number:
Reference checking
Yes
No
Do you consent to us contacting your present or previous employers for the purpose of
reference checking?
If no, no approach will be made to your current employer until you agree. An offer will be
conditional upon receipt of satisfactory references.
Page 1 of 4
Application form for Employment –
New Zealand
Te Toi Tupu – Leading Learning Network
Please complete the table below. We require a minimum of two Referees and these people should be
individuals you have directly reported to in previous roles.
Note: This section needs to be completed regardless of whether it is detailed in your CV.
Referee One:
Referee Two:
Referee Three:
Name:
Title:
School/Company:
Contact Details (phone and
email):
Health
Yes
No
Do you have any illness, injury, condition or health problem that may affect your ability to
perform the duties of the position?
If yes, please provide details.
Right to work in New Zealand / Criminal convictions
Yes
No
Are you a New Zealand Citizen / Do you have permanent residency?
If you answered no to the previous question, are you legally entitled to take up permanent
employment in New Zealand?
(You will be required to produce evidence (including sight of your passport). Please attach a
copy to this application)
Have you ever been convicted of a criminal offence 1 or are you awaiting the hearing of any
criminal charges? (if Yes, please give details)
Have you had any dealings with the Police?
1
(If Yes, please give details)
Under the Criminal Records (Clean Slate) Act 2004, you do not need to declare your New Zealand conviction if all the following apply:
(a)
(b)
(c)
It has been 7 or more years since your most recent conviction and you have not re-offended; and
You have never had a custodial sentence imposed upon you (including detention at home, in hospital or at any secure facility); and
You have paid any fines/costs/compensation/reparation.
Regardless of how long ago you were convicted, you are not eligible to conceal your conviction if:


you have ever been convicted of a sexual offence; or
you have ever been disqualified from holding a driver licence for repeat offending involving alcohol/drugs; or
Page 2 of 4
Application form for Employment –
New Zealand
Te Toi Tupu – Leading Learning Network
Please sign and return the consent form attached to this application form which allows us to contact the NZ
Police for information relating to whether you have a criminal record. These checks are subject to the
Criminal Records (Clean Slate) Act 2004.
Declaration
I declare that the information I have submitted with this form and in connection with my application for
employment is true and correct. I understand that if any false information is given, or material suppressed,
I may not be accepted or if I am employed, my employment may be immediately terminated.
I irrevocably authorise you or your agent to contact any or all of my previous and current employers,
including any employers that I have not nominated on this application. Information so gained, is supplied in
confidence as evaluative material and will not be disclosed to me.
I understand that any offer of employment made by a Te Toi Tupu partner is subject to police vetting and
that my employment may be terminated if information is obtained through this process which affects my
suitability for employment.
Because this role involves budget management, I consent to Te Toi Tupu seeking information from credit
checking agency Veda Advantage (NZ) Ltd to determine my suitability for this position. I understand my
birth date is required for this and it is ______________________ .
I understand that Te Toi Tupu may contract out its recruitment checking process to an external contractor
(Employrite Ltd), and consent to the information contained in my application, and the results of the credit
check and criminal record check, being held, accessed and used by Te Toi Tupu and Employrite Ltd.
In accordance with the Privacy Act 1993, Te Toi Tupu agrees to destroy any material sourced and made
available to it as a result of credit and criminal record checks as soon as this material has been reviewed, a
decision as to employment suitability has been made, and it is no longer required.
I understand that if I am successful in obtaining employment with Te Toi Tupu, my application will be
reviewed by Employrite Ltd.
I am entitled to seek access to the material held by Employrite about me. However, the Privacy Act also
allows refusal of access in some circumstances. If the information held about me by Employrite is incorrect I
may ask that it be corrected. Employrite can be contacted at PO Box 26624 Epsom, Auckland.
I further irrevocably authorise Te Toi Tupu partners to furnish to Employrite, details of this application and
any subsequent dealings that I may have with Te Toi Tupu as a result of this application being actioned by
Te Toi Tupu.
I irrevocably authorise Employrite Ltd to furnish to relevant Te Toi Tupu partners the details of any criminal
or driver’s history.
I HAVE READ AND FULLY UNDERSTAND THIS DECLARATION:

the conviction was from overseas;
Page 3 of 4
Application form for Employment –
New Zealand
Te Toi Tupu – Leading Learning Network
Signed
Dated
Page 4 of 4