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Registration (Step1) - Personal Information

If you are concerned with issues of privacy, please read our Privacy Statement
Please note: (Y = Yes, N = No) and fields coloured yellow and marked with a are required fields.
  Title           First Names:
Surname (Last Name):
Choose desired category of employment (1):
  Date of Birth:(dd/mm/yyyy)
Known as / Nickname:
Choose desired category of employment (2):
  Job number:
If you are registering for a specific advertised position, please enter the job number here.
If you are already dealing with one of our Consultants, please choose that person here.
Phone Numbers
Road, Street etc:
Business: eg: 03 365 4322

  Fax: eg: 03 365 4322

Home: eg: 03 365 4322

  Cell: eg: 0274 331 3233

  Other Contact:
If not NZ Citizen or Resident
    New Zealand or Australian Citizen Nationality
    Permanent NZ Resident Passport Issuing Country (or Country of Birth)
    Hold NZ Work Permit Passport No.
    Require NZ Work Permit Work Permit No.
Expires (dd/mm/yyyy)
  How did you first hear about us?
  Date of arrival in NZ (if overseas)
Work Sought
Y      N

Y      N
        Temporary/Contract       Permanent
        Full Time       Full Time
        Part Time       Part Time
        Have you Temped before?       Are you currently employed?
  Available to start (dd/mm/yyyy)
Position Sought
  For How Long?
Preferred Location
Hold NZ Drivers Licence
Normal Method of Transport to Work
  Full Own Car
  Restricted Public Transport
  Learner Other: 
  None Do you have any convictions against the law?
Industrial & Construction only
Y      N
        Steel capped work boots?
        Are the caps inside?
        Do you have any dependants?
        Do you smoke?
  Have you had?
Y      N
Do you suffer from?
Y      N
        Asthma       Earache, deafness
        Bronchitis       Skin infections
        Dermatitis or eczema       High blood pressure
        Hernia       Heart problems
        Back injury or strain       Diabetes
        Blackouts or seizures       Any allergies
        ACC compensation       Colour blindness
  If yes, dates of incidents       OOS (RSI)
  Y      N
           I have marked all the relevant boxes above which relate to my personal health
        Do you wear corrective lenses?
        Are you taking drugs or medicine?
  How many sick days have you taken in the past 12 months?
  0 - 5
  6 - 10
  11 - 15
  16 - 20
  Over 20 days
  Please give details of anything else which might affect your performance,
or which the Company should know about