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Home
Our School
Pepeha
Mission Statement
Enrolment
Key Features
Special Features
Our People
Information
Vacancies
School Docs & Charter
Ero Report
Newsletters
Shop
Contact
Update Student details
Absences
Vacancies Application
Personal Details
First Name
Surname
Address
Email
Phone
Can you speak any languages other then English
Yes
No
If “Yes”, please detail:
NZ Teacher Registration
Date of Birth
Ethnicity
Position you are applying for
Availability
Fulltime
Part-Time
Personal
Mr
Mrs
Miss
Ms
Identity Verification, Criminal Record and Right to Work
Please tick the appropriate boxes:
Are you a New Zealand Citizen?
Yes
No
If not, do you have resident status?
Yes
No
Or a Current work permit?
Yes
No
Have you ever had a criminal conviction?
Yes
No
If “Yes”, please detail:
Have you ever received a police diversion for an offence?
Yes
No
If “Yes”, please detail:
Have you ever been discharged without conviction for an offence?
Yes
No
If “Yes”, please detail:
Do you have a current New Zealand driver’s licence?
Yes
No
Have you ever been convicted of a driving offence which resulted in temporary or permanent loss of licence, or imprisonment?
Yes
No
If “Yes”, please detail:
Are you awaiting sentencing or do you have charges pending?
Yes
No
If “Yes”, please state the nature of the conviction/cases pending:
In addition to other information provided are there any other factors that we should know to assess your suitability for appointment and your ability to do the job?
Yes
No
If “Yes”, please detail.
Have you ever been the subject of any concerns involving child safety?
Yes
No
If “Yes”, please detail.
Have you had an injury or medical condition caused by gradual, process, disease or infection, such as occupational overuse syndrome which the tasks of this position may aggravate or contribute to?
Yes
No
If “Yes”, please detail.
Employment History:
Please list your work experiences for the last five years beginning with your most recent position. Please explain any gaps in employment. If you were self-employed give details.
1. Employers Name
Position Held
Start Date
End Date
Reason for leaving
2. Employers Name
Position Held
Start Date
End Date
Reason for leaving
3. Employers Name
Position Held
Start Date
End Date
Reason for leaving
4. Employers Name
Position Held
Start Date
End Date
Reason for leaving
5. Employers Name
Position Held
Start Date
End Date
Reason for leaving
6. Employers Name
Position Held
Start Date
End Date
Reason for leaving
Qualifications relevant to the position:
Qualification
Year Attained
School or University
Qualification
Year Attained
School or University
Qualification
Year Attained
School or University
Referees:
Please provide the names of three people who could act as referees for you. One of these should be your current or most recent employer. Please indicate which referee is your current/previous employer in the table below. If you have included written references from people other than those recorded below, please note that we may contact the writers of these references.
Name
Organisation
Position / Relationship
Contact Number
Name
Organisation
Position / Relationship
Contact Number
Name
Organisation
Position / Relationship
Contact Number
I authorise the Board, or nominated representative, to approach persons other than the referees whose names I have supplied, to gather information related to my suitability for appointment to the position.
Yes
No
I authorise the Board, or nominated representative, permission to access any information held by the Education Council of Aotearoa New Zealand (EDUCANZ) for any other education organisation, including information regarding matters under investigation, to gather information related to my suitability for appointment to the position.
Yes
No
If your application is successful when could you commence employment?
I certify that:
The information I have supplied in this application is true and correct.
• I confirm in terms of the Privacy Act 1993 that I have authorised access to referees.
• I know of no reason why I would not be suitable to work with children/young people.
• I understand that if I have supplied incorrect or misleading information, or have omitted any important information I may be disqualified from appointment, or if appointed, may be liable to be dismissed.
Signature
Date
Any supoorting documents
Send
