The purpose of this application form is to obtain information from you to assist us to make a decision regarding your suitability for the position applied for.
This information will be held by the Human Resources department and will only be made available to those responsible for making the selection.
If your application is unsuccessful, your information will be held for a period of 90 days and after that time will be destroyed. If successful, the information will form the basis of your payroll details.
Please provide as much detail as possible. Fields marked with * are required.
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Have you been / are you known by any other names*
Are you a NZ citizen or resident*
If "No", are you legally entitled to work in NZ
Please provide an explanation of your immigration status
Do you have a current NZ Drivers Licence*
If "Yes", what licence, classes and endorsements do you hold (please select as many as apply)
Have you been previously employed by the Dunedin City Council*
A criminal charge is one in which it is alleged that you have broken the law in some way. We do not include traffic offences other than drink driving or convictions that are subject to the Criminal Records (Clean Slate) Act 2004.
Have you been convicted of any criminal offence punishable by imprisonment or do you have criminal charges pending*
The following information is required to assist the Dunedin City Council to meet its obligations under Health and Safety legislation.
Confirmation of the appointment of the successful applicant may be subject to the receipt of a satisfactory medical certificate. The cost of the medical examination will be borne by the Council.
Have you had any injuries or medical conditions (for example hearing loss, sensitivity to chemicals, occupational overuse injuries or back injuries) that the tasks of this job may aggravate or contribute to or prevent you from carrying out the functions of the position*
Dunedin City Council's recruitment process requires you to supply a current Curriculum Vitae (CV) for each vacancy that you apply for. You may also provide a cover letter.
You will need to give details of at least 2 referees whose consent has been obtained and who may be contacted for a confidential reference. Where possible, references should be able to give work-related information that will assist with this application. These may be included in your CV or provided on this form.
As a security measure, please enter the 5 characters from the security key image below into the text field to the right. Characters are all lower case. If you cannot read the text, click the 'regenerate' link for a new security image.
Regenerate security key
Please read the below declaration and indicate that you have read and accept it. This application will not be able to be submitted without accepting the declaration.
I understand that I may access personal information about me held by the Dunedin City Council and request correction of that information.
This access to information excludes reference checks undertaken by the Dunedin City Council and all evaluation or opinion material compiled by the Dunedin City Council for the purpose of assessing my suitability, eligibility and qualifications for employment.
I declare that I have disclosed to the Dunedin City Council all information reasonably having a bearing on whether or not the Dunedin City Council might employ me.
I understand that if I am employed and if I have withheld any such information, my employment might be terminated for that reason alone.
I have read and accept the above declaration *
Last reviewed: 16 Nov 2009 9:47am
