Candidate Form – AR Staffing Solutions

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First Name

Last Name

Date Of Birth

Gender

Mobile

Address

Skills

Type Of Employment

Part Time Full Time Casual

Preference Of Shift

Morning Evening

Have you ever had a medical condition or injury (either physical or mental) or substance dependencies which may be aggravated by or affect your ability to undertake the full responsibilities or functions of any position we are likely to find for you or require special working conditions or equipment ?

Yes No

If Yes, please provide details

Do you have any criminal convictions, not including any concealed under the Criminal Records (Clean Slate) Act 2004?

Yes No

If Yes, then provde convictions in detail

Emergency contact name

Emergency contact number

Name of a Referee

Relationship with the Referee

Email Address of Referee

Mobile of Referee

Working Rights In New Zealand