Personal Details

Mr/Miss/Ms/Mrs (Circle one)

Last Name: First Name: Preferred Name:

D.O.B: / / (optional) Sex: Male/Female (circle)

Address: NZ Ph: UK Ph:

E-mail:

Alternative Contact Name:

Postcode:
Alternative Contact Number:
Preferred Location of Employment:
Back Home Number:

Where is “Home” for you?

□ New Zealand □ Australia □ UK □ Other _______________________

Work Eligibility in NZ:

□ NZ Passport Holder □ Australian Passport Holder □ Working Holiday Visa, Expiry date: ________________
□ Other (please specify) ____________________ Expiry date: ____________________
□ Eligibility for alternative visa _____________________
How did you hear about us?
□ Australasian Recruitment Company (London) □ Personal Referral (please specify) __________________
□ Trade Me □ SEEK □ LinkedIn □ Google □ Contacted by Home Recruitment Directly
□ Kiwis in London Groups (please specify) _______________ □ Other __________________
□ Temp □ Contract □ Permanent □ Part-time Date available from: / /

Holidays planned? From: To:

Current/Most Recent Employment

Company Name:

Job Title: Temp/Contract/Perm:

Start Date: Notice Period: Date Avail:

Current Salary/Hourly Rate: Benefits:

Required Salary/Rate:
 TECHNICAL SKILLS

MS Office
Word
Excel
Excel Macros
Excel V Look Ups
Excel Pivot Tables
PowerPoint
Access
Projects

G-Suite
Gmail
Googledocs
Google analytics

Adobe Suite
InDesign
Illustrator
PhotoShop

Marketing/Communications
Tweetdeck
Hootsuite
Wordpress
Mailchimp
Survey Monkey
Shopify

Document Control/Construction design

Conject
Acconex
AutoCad
4Projects
Sketch-up
CRM/Accounting systems
Salesforce
Raisers Edge
Microdec profile
Xero
SAP
Sage
Oracle
QuickBooks

Other
Condeco
macOS
HTML
CSS

LANGUAGES
Please specify:
 DISCLOSURE AND CONSENT FORM

Under the Privacy Act 1993, Home Recruitment has certain obligations relating to the collection,
storage and use of candidates’ personal information. Home Recruitment wishes to carry out its
obligations under the Privacy Act fully, and therefore asks that you sign this form to indicate that you
have read and consented to the following:

1. Home Recruitment may provide information about you, whether provided by you or a third
party (“your information”) to a prospective employer after having briefed you on the
proposed position with that employer. Home Recruitment may provide your information to a
range of possible employers with your verbal and written agreement.

2. Home Recruitment may contact, and collect your information from, any former employer or
any person named by you as a referee.

3. Your information is held by Home Recruitment, Auckland for the purposes of seeking suitable
employment for you and maintaining your records, and may also be held by the prospective
employers.

4. After you accept an offer of employment your information will form part of Home
Recruitment records but will be held in confidence and not disclosed to anyone, including any
prospective employers, without your consent.

5. You undertake that all information provided by you is correct, complete and not misleading
and understand that failure to provide information, or the provision of incorrect or
misleading information, breaches your agreement with Home Recruitment and may also be
grounds for dismissal by an eventual employer.

6. You have rights of access to and correction of your information.

Name

Signature

Date
 REFERENCES FROM OVERSEAS

Company: Company:

Contact Name: Contact Name:

Contact Position: Contact Position:

E-Mail Address: E-Mail Address:

Telephone Number: Telephone Number:

Your Job Title: Your Job Title:

Dates Employed: Dates Employed:

Do you authorise us to contact this Referee? Do you authorise us to contact this Referee?
Yes No Yes No

REFERENCES WITHIN NEW ZEALAND

Company: Company:

Contact Name: Contact Name:

Contact Position: Contact Position:

E-Mail Address: E-Mail Address:

Telephone Number: Telephone Number:

Your Job Title: Your Job Title:

Dates Employed: Dates Employed:

Location or address: Location or address:

HR Contact: HR Contact:

Number of Employees: Number of Employees:

Industry Sector: Industry Sector:

Were you Temp/Contract/Permanent: Were you Temp/Contract/Permanent:

Reason for Leaving: Reason for Leaving:

Do you authorise us to contact this Referee? Do you authorise us to contact this Referee?
Yes No Yes No
 CRIMINAL CONVICTIONS DECLARATION

Home Recruitment promote equality of opportunity for all with the right mix of talent, skill and
potential and welcome applications from a wide range of candidates, including those with criminal
records. We select all candidates for submission of CV to our clients based on their skills,
qualifications and experience and will only consider an applicant’s criminal record where it is relevant
to the post.

If offered a role by one of our clients, you may be required to verify the information given here by
obtaining a satisfactory basic disclosure from the relevant Criminal Records Bureau or be asked to
give your authorisation for one to be gained.

Do you have any criminal convictions that are not covered by the Criminal Records (Clean

Slate) Act 2004? Yes No

You’re said to have no criminal record (criminal conviction history) if ALL of the following are true.
If you have:
 had no convictions within the last 7 years
 never been sentenced to a custodial sentence (such as prison, corrective training or borstal)
 never been convicted of a sexual offence (‘specified offence’)
 fully paid any fine, compensation, reparation or costs ordered by the court in a criminal case
 never been banned from driving until further notice (indefinite disqualification)
 never been held in hospital by the court in a criminal case instead of being sentenced, due to
your mental condition.

If you have answered ‘Yes’ to the above question, please give details:

Offence Details Sentence Date of Sentence

Name

Signature

Date