APPLICATION FOR EMPLOYMENT

Date of Application *

Role applied for *

Supported Living Facilitator CaregiverResidential Support Worker

You may apply for multiple roles. If you are shortlisted, you will be considered for the role that best matches your skills, experience, and suitability, as determined through the interview process. Suitability for a position will also be determined based on the location and the role being advertised.

If you chose current employee or other, please provide details, incluidng name if referred by current employee *

If another position which you may be suitable for arises at Renaissance, do you consent to us retaining the information contained in this application form if we would like to consider you for the role *

YesNo

Personal Information

Title (Mr, Mrs, MIss, Ms, Other) *

First Name *

Last Name *

Name you prefer to be called by

Are you known by any other names

Email Address *

Mobile Number *

Address *

Street address *

Suburb *

City *

Postcode *

Which languages can you hold everyday conversation in? *

Please tell us about any interests, hobbies, sports, clubs, or community activities you participate in. *

Do you have a spouse, partner, relative or member of your family household working at Renaissance Group? *

YesNo

If yes, please provide details *

Right to work in New Zealand

Please indicate your current visa or residency status *

If you chose Other please specify the visa type *

Visa Expiry Date *

Qualifications and Training

Highest Qualification Gained *

Name of Institution *

Country of Institution *

Please list any qualifications relevant to this role.

Are you currently studying? *

Yes No

If yes, please provide details of your current study and expected completion date. *

Work History

Current Employer Name *

Job Title *

Employment start date *

Employment end date

Referees

Please provide details for two referees from your two most recent employers.It can also include paragraphs.

Referees Full Name *

Organisation *

Mobile Number *

Email Address *

Availability for work

If you are successful, how much notice do you need to give to your current employer or when can you start work *

How many hours are you available to work a week? *

Please specify the times you are available to work on the days selected above. *

Are you flexible to work additional days or varied hours if required? *

YesNo

Are you available to work weekends, evenings, or public holidays if required? *

YesNo

Is there anything further you would like us to know about your availability? *

Do you plan to work for another organisation/company/individual as well as Renaissance Group if you are successful? *

Yes No

If you answered Yes to the previous question, please provide details of the other employment. *

Driving Information

If you selected No licence or overseas licence please provide details.

Please provide your driver licence expiry date *

Do you own a reliable vehicle for work as a support worker in the community? *

YesNo

Are you willing to travel between client locations? *

YesNo

Are you comfortable driving in all weather and traffic conditions? *

YesNo

Criminal & Traffic Offending

Have you been convicted or charged with a criminal offence in the last seven years? *

YesNo

If yes, please provide details *

Do you have any pending criminal charges or current court proceedings? *

YesNo

If yes, please provide details *

Have you ever been charged or convicted of a driving related offence, including drink driving, dangerous driving, or licence related offences in the last seven years? *

YesNo

If yes, please provide details *

Do you currently have any demerit points, licence suspensions, or driving restrictions that may affect your ability to perform this role? *

YesNo

If yes, please provide details *

Do you have any pending driving related charges, court proceedings, or investigations? *

YesNo

If yes, please provide details *

Have you ever been sentenced to imprisonment or detention for any offence? *

YesNo

If yes, please provide details *

Are you willing to undergo Police Vetting and other pre employment checks relevant to this role? *

YesNo

Have you ever been subject to any investigation, disciplinary action, or findings relating to the care, safety, or wellbeing of vulnerable people?

YesNo

If yes, please provide details *

Have you been the subject of a diversion ordered by the courts? *

YesNo

If yes, please provide details *

Medical & Wellbeing

Are you aware of any physical, psychological, or health related condition that may affect your ability to safely perform the inherent requirements of this role? *

YesNo

If yes, Please provide any information you would like us to consider in relation to support, accommodations, or workplace adjustments *

Have you previously experienced a work related injury that required time away from work? *

YesNo

If yes, please provide details *

Have you taken extended or frequent leave from work in the past 12 months due to injury or illness that may affect your ability to perform this role? *

YesNo

If yes, please provide details

Do you currently smoke or vape? *

YesNo

Declaration

I, (enter your full name) *

declare that, to the best of my knowledge, the information provided in this application, and in any attached resume or supporting documents, is true and accurate. I understand that providing false, misleading, or incomplete information may affect my application or, if employed, may result in disciplinary action, including termination of employment.

I understand that under the Accident Compensation Act, providing false or misleading information in relation to any injury, gradual process injury, disease, or infection may affect eligibility for ACC entitlements.

Criminal Records Disclaimer: For roles involving the care or support of vulnerable people, we may request information regarding criminal and traffic convictions, including convictions that may not otherwise need to be disclosed under the Criminal Records (Clean Slate) Act 2004.

For further information about the Criminal Records (Clean Slate) Act 2004, please visit www.justice.govt.nz

Select Yes if you are giving your consent to the above electronically. Please note thatif you do not select yes we will be unable to process your application. *

YesNo

Date consent given

Upload a copy of your CV *

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