Date *

MM

DD

YYYY

Name *

First Name

Last Name

Are you legally entitled to work in New Zealand? *

Proof of eligibility required (EG. Birth Certificate, Passport)

Yes

No

Do you have a current driver’s licence? *

Learners

Restricted

Class 1 - Car

Class 2 – Med Rigid

Class 3 – Med Combination

Class 4 - Heavy Rigid

Class 5 – H / Combination

Class 6 – Motorcycle

Do you have any demerit points? *

Yes

No

Have you ever been dismissed by an employer? *

Yes

No

Have you been convicted of a criminal offence? *

(You may answer no if you meet the eligibility criteria of the Criminal Records Clean Slate Act 2004)

Yes

No

Are you awaiting the hearing of civil or criminal charges? *

Yes

No

Do you have any health or other known conditions which may affect your ability to carry out the responsibilities of this position? *

Yes

No

Are you presently receiving medical treatment and/or medication? *

Yes

No

Have you had any ACC claims in the last five years? *

Yes

No

Are you currently employed? *

Yes

No

Consent to Retain Information: Should you not be offered employment at this time do you request that Montana Food and Events retains this application and supporting documentation for up to six months should any other suitable position become available? *

Yes

No

I certify that the answers I have provided to the questions in this application form are true and complete to the best of my knowledge. This also applies to the information contained in any supporting documents I have provided. I understand that if any information is false or misleading or material fact is suppressed I will not be employed or if discovered after my employment, will result in the termination of my employment. Any false information in relation to my medical history may result in my loss of entitlement for any compensation from ACC. *

I certify

I consent to Montana Food and Events seeking verbal or written information about me from the referees I have nominated and authorise the information required to be released. *

I consent

I understand that the information collected is for the purpose of assessing my suitability for employment with the Company and the Company is under no obligation to offer me employment. *

I understand

Evidence of Entitlement to work in New Zealand will be required from Both New Zealand Citizens and non- New Zealanders during the recruitment stage *

I agree