PERSONAL DETAILS
Date:_________________________Position Applying for:_______________________________________
Name (first/last):________________________________________________________________________
Your preferred name:_____________________________ Mobile:_________________________________
Address:_______________________________________________________________________________
Email:_____________________________ Home Ph:___________________ Work Ph:__________________
Tertiary Education/Training:
Qualification Establishment Years attended Location
______________________________________________________________________________________
______________________________________________________________________________________
Professional Memberships:
Professional Body Membership Status/Type Member/Registration # Member since
______________________________________________________________________________________
______________________________________________________________________________________
EMPLOYMENT
Current/Most recent position:___________________________________________________________
Company Name:___________________________________Reporting to:________________________
Location:________________________Staff Size:_________Dates Employed:_____________________
Salary Package:____________________________________Notice Period:_______________________
Reason for leaving:____________________________________________________________________
____________________________________________________________________________________
REFEREES First Second Third
Name: ______________________________________________________________________
Title: ______________________________________________________________________
Company: ______________________________________________________________________
Email Address ______________________________________________________________________
Tel/Mobile: ______________________________________________________________________
Relationship: ______________________________________________________________________
Contacted by you?_____________________________________________________________________
GENERAL INFORMATION
Are you a New Zealand citizen? YES / NO If NO are you a Permanent Resident? YES /NO
Only complete if not a NZ citizen.
Work Visa #__________________________ Expiry Date__________________ Passport #:__________________________
How long have you worked in NZ?__________________ Do you have a current NZ Drivers Licence # _____________________
Have you been convicted of a criminal offence in the last ten years? YES / NO If yes please provide brief details:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Are you waiting the hearing of charges in court? YES / NO If yes please provide brief details:
_______________________________________________________________________________________
Have you ever had an injury or medical (physical or psychological) condition, including those caused by a gradual process, disease or infection, which may be aggravated by, or affect your ability to undertake the functions and responsibilities of the position applied for, or impact adversely on the company its business or staff? YES / NO
Do you have any substance dependency? YES /NO
If yes to either of the above please describe briefly:
_______________________________________________________________________________________
_______________________________________________________________________________________
Any holidays or time-off planned in the next 12 months? (If yes please provide details/dates)
_______________________________________________________________________________________________________
How did you hear about the job with Sage Recruitment Ltd (eg. Seek, Referral, Publication, other):
________________________________________________________________________________________________________
YOUR SEARCH PROCESS/PROGRESS
Are you registered or have contacted any other recruitment agencies? YES / NO
If yes please provide details (including interviews planned):
Have you applied for this or any other roles direct to organizations? YES / NO
If yes please provide details (including interviews planned or offers pending):
DECLARATION & CONSENT
I certify that all information I have provided to you is true, accurate and complete.
I understand that all information provided about me to you will be held by you and used for the purpose of evaluating my qualifications and suitability for permanent and/or temporary employment.
I authorise you to contact any person nominated by me and seek further information from them which may be relevant to my application for employment.
I understand that if I, withhold relevant information about me, my application may not be further considered.
I authorize you to retain any information about me until I advise you that I no longer wish to seek employment opportunities through you and that I wish to delete or destroy that information. I understand that you may retain non-active information about me on your database, unless I request otherwise.
PRINTED NAME:___________________________________ SIGNED:_____________________________DATE:______________
YOUR CAREER PREFERENCES
Name:_________________________________________________________________________________
What roles/positions will you consider? (including specific industry areas of interest, size of organisation, public/private sector)
______________________________________________________________________________________
What locations will you consider (including outside of Auckland):
_______________________________________________________________________________________
What hours of work options will you consider (days and hours):
_______________________________________________________________________________________
What don’t you enjoy in a company or position?
Include anything that would deter you from looking at this type of role or company.
_______________________________________________________________________________________
What are your plans for the next few years? (including career, study and travel)
_____________________________________________________________________________________
If you were appointed to this role, what contribution you would make?
_______________________________________________________________________________________
Date:_________________________Position Applying for:_______________________________________
Name (first/last):________________________________________________________________________
Your preferred name:_____________________________ Mobile:_________________________________
Address:_______________________________________________________________________________
Email:_____________________________ Home Ph:___________________ Work Ph:__________________
Tertiary Education/Training:
Qualification Establishment Years attended Location
______________________________________________________________________________________
______________________________________________________________________________________
Professional Memberships:
Professional Body Membership Status/Type Member/Registration # Member since
______________________________________________________________________________________
______________________________________________________________________________________
EMPLOYMENT
Current/Most recent position:___________________________________________________________
Company Name:___________________________________Reporting to:________________________
Location:________________________Staff Size:_________Dates Employed:_____________________
Salary Package:____________________________________Notice Period:_______________________
Reason for leaving:____________________________________________________________________
____________________________________________________________________________________
REFEREES First Second Third
Name: ______________________________________________________________________
Title: ______________________________________________________________________
Company: ______________________________________________________________________
Email Address ______________________________________________________________________
Tel/Mobile: ______________________________________________________________________
Relationship: ______________________________________________________________________
Contacted by you?_____________________________________________________________________
GENERAL INFORMATION
Are you a New Zealand citizen? YES / NO If NO are you a Permanent Resident? YES /NO
Only complete if not a NZ citizen.
Work Visa #__________________________ Expiry Date__________________ Passport #:__________________________
How long have you worked in NZ?__________________ Do you have a current NZ Drivers Licence # _____________________
Have you been convicted of a criminal offence in the last ten years? YES / NO If yes please provide brief details:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Are you waiting the hearing of charges in court? YES / NO If yes please provide brief details:
_______________________________________________________________________________________
Have you ever had an injury or medical (physical or psychological) condition, including those caused by a gradual process, disease or infection, which may be aggravated by, or affect your ability to undertake the functions and responsibilities of the position applied for, or impact adversely on the company its business or staff? YES / NO
Do you have any substance dependency? YES /NO
If yes to either of the above please describe briefly:
_______________________________________________________________________________________
_______________________________________________________________________________________
Any holidays or time-off planned in the next 12 months? (If yes please provide details/dates)
_______________________________________________________________________________________________________
How did you hear about the job with Sage Recruitment Ltd (eg. Seek, Referral, Publication, other):
________________________________________________________________________________________________________
YOUR SEARCH PROCESS/PROGRESS
Are you registered or have contacted any other recruitment agencies? YES / NO
If yes please provide details (including interviews planned):
Have you applied for this or any other roles direct to organizations? YES / NO
If yes please provide details (including interviews planned or offers pending):
DECLARATION & CONSENT
I certify that all information I have provided to you is true, accurate and complete.
I understand that all information provided about me to you will be held by you and used for the purpose of evaluating my qualifications and suitability for permanent and/or temporary employment.
I authorise you to contact any person nominated by me and seek further information from them which may be relevant to my application for employment.
I understand that if I, withhold relevant information about me, my application may not be further considered.
I authorize you to retain any information about me until I advise you that I no longer wish to seek employment opportunities through you and that I wish to delete or destroy that information. I understand that you may retain non-active information about me on your database, unless I request otherwise.
PRINTED NAME:___________________________________ SIGNED:_____________________________DATE:______________
YOUR CAREER PREFERENCES
Name:_________________________________________________________________________________
What roles/positions will you consider? (including specific industry areas of interest, size of organisation, public/private sector)
______________________________________________________________________________________
What locations will you consider (including outside of Auckland):
_______________________________________________________________________________________
What hours of work options will you consider (days and hours):
_______________________________________________________________________________________
What don’t you enjoy in a company or position?
Include anything that would deter you from looking at this type of role or company.
_______________________________________________________________________________________
What are your plans for the next few years? (including career, study and travel)
_____________________________________________________________________________________
If you were appointed to this role, what contribution you would make?
_______________________________________________________________________________________
