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Home
Services
Accommodation
Alcohol, other drugs and gambling addiction
Child and Youth
Community Support
Consumer Advisors and Peer Support
Employment / Vocational
Family / Whanau Support
Fetu Ola Pasifika
Financial Capability (Budget Advice)
Heartlands Service Centres
Improving Mental Health (Corrections)
Individually-Funded Services
Intensive Monitoring (Corrections)
NIDSAS
Social Networking Centres
Working with Māori
About Us
Overview
Locations
Contract List
Board and Executive Team
Mission, Vision, Values and Attitudes
History
Work for us
Why work for PACT?
Careers at Pact
Contact
Pact Job Application Form
APPLICATION FOR EMPLOYMENT
Please note you cannot attach a CV or Cover letter to this application so please utilise this form to give as much information as you can to express you interest and what would be contained in your CV and cover letter. If we require further information we will request this via email
Application date
*
MM
DD
YYYY
Job Code
*
(If no job code listed please type NC)
Position applying for
*
APPLICANT DETAILS: Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Contact Number
*
Other Number
Email Address
*
LEGAL ENTITLEMENT TO WORK IN NEW ZEALAND
*
New Zealand citizen
Permanent resident
Current work visa
If you have a work visa, what is the expiry date?
MM
DD
YYYY
PREVIOUS EMPLOYMENT: Has Pact previously employed you?
*
Yes
No
If yes, please provide details of the latest period of employment
Please note that Pact reserves the right to use any relevant employment related information that it might hold about you as an employee when assessing your suitability for the position you are applying for
WORK EXPERIENCE
PRESENT OR MOST RECENT EMPLOYER: Company Name
*
JOB TITLE & RESPONSIBILITIES
*
Company Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start Date
*
MM
DD
YYYY
Finish Date
*
MM
DD
YYYY
Contracted Hours
*
Full Time
Part Time
Casual
Other
Reason for Leaving
*
NEXT MOST RECENT EMPLOYER: Company Name
*
JOB TITLE & RESPONSIBILITIES
*
Company Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start Date
*
MM
DD
YYYY
Finish Date
*
MM
DD
YYYY
Contracted Hours
*
Full Time
Part Time
Casual
Other
Reason for Leaving
*
NEXT MOST RECENT EMPLOYER: Company Name
JOB TITLE & RESPONSIBILITIES
Company Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start Date
MM
DD
YYYY
Finish Date
MM
DD
YYYY
Contracted Hours
Full Time
Part Time
Casual
Other
Reason for Leaving
PLEASE ADD ANY FURTHER EMPLOYMENT HISTORY YOU FEEL IS RELEVANT
QUALIFICATIONS
Educational Institution
From
MM
DD
YYYY
To
MM
DD
YYYY
Qualification Gained
Educational Institution
From
MM
DD
YYYY
To
MM
DD
YYYY
Qualification Gained
Educational Institution
From
MM
DD
YYYY
To
MM
DD
YYYY
Qualification Gained
Educational Institution
From
MM
DD
YYYY
To
MM
DD
YYYY
Qualification Gained
PLEASE ADD ANY FURTHER QUALIFICATIONS YOU FEEL ARE RELEVANT
COMPETENCIES & SKILLS: List any additional skills, attributes, or competencies you feel are relevant to your application.
*
DRIVER LICENCE
Do you have a current full driver licence?
*
Yes
No
Can you drive a manual car?
*
Yes
No
CRIMINAL HISTORY
Have you ever been convicted of any offences against the law in New Zealand or in any other country (other than minor traffic or parking offences)?
*
Yes
No
If yes, please provide details and dates of conviction(s)
Do you have any cases pending?
*
Yes
No
If yes, please provide details and dates
MEDICAL HISTORY
Are you suffering from, or have you ever suffered from, injuries or medical conditions caused by gradual process, disease or infection (e.g. hearing loss, repetitive strain injuries, back injury), which the tasks of this job may aggravate or contribute to?
*
Yes
No
If ‘Yes’, please give details
Do you have any other physical or mental conditions not stated above that may affect your ability to perform the duties required for this job?
*
Yes
No
If ‘Yes’, please give details
Are you on any medications that may affect your ability to perform the duties required for this job?
*
Yes
No
If ‘Yes’, please give details
AVAILABILITY
Date Available to Start
MM
DD
YYYY
Or Period of Notice Required in Current Employment
Please tick ALL boxes that you are available for
*
Full Time
Part Time
Weekends Only
Mornings
Afternoons
Evenings
Awake Night Shifts
Sleeping Night Shifts
If not available full time please indicate the number of hours you are available per week
Are there any days or hours you cannot work? (If so, please give details)
*
Do you have any holidays booked? (If so, please give dates that you will be away)
*
Do you currently have any limitations on maximum hours worked/income per week? (If so, please give details)
*
REFEREES
Please provide the names of at least two referees (whose consent has been obtained and who may be contacted for a confidential reference.). At least one should be a Supervisor, or Manager whom you have worked for.
Can we contact your current employer?
*
Yes
No
MOST RECENT OR CURRENT EMPLOYER: Company Name
*
Person's Name
*
First Name
Last Name
Position
*
Contact Phone Number
*
Is this your current employer?
*
Yes
No
NEXT MOST RECENT EMPLOYER: Company Name
*
Person's Name
*
First Name
Last Name
Position
*
Contact Phone Number
*
If you have not been employed before or are returning to work after several years please provide contact details of people from whom confidential (personal) references can be obtained (this person is to be a non family members whom you have known for a minimum of two years).
Name
Contact Number
Name
Contact Number
If there is anything further you wish to add to support your application please feel free to add it below
*
Please paste your cover letter below
Collection/Storage/Purpose of personal information
The information you provide on this Employment Application Form is being collected and will be held by Pact for the purpose of assessing your suitability for employment and/or re-employment with Pact, which may include subsequent changes in employment within the organisation. This information is also being collected for the purpose of complying with all employment related legislation such as the Accident Compensation Corporation (ACC), and Health & Safety. Failure to complete all sections truthfully will render this application invalid and, should you have been successful in your application, can be grounds for dismissal. Failure to provide accurate information in the medical section may also result in your loss of entitlement to ACC. This information shall be held securely in the organisation's personnel file and only appropriate personnel shall have access to it. No information will be disclosed to third parties without your authorisation except as required by law. you have the right to view your personal information and may request correction if necessary. If your application is unsuccessful it will be held for a period of three months after which it shall be destroyed.
Declaration
I,
*
declare that to the best of my knowledge the answers given in this application are complete and correct, and that the information provided in my curriculum vitae is correct. I understand that provision of incorrect or misleading information may result in my summary dismissal. I understand that if any false information is given or any material fact suppressed, I may be disqualified from consideration or, if appointed, I may be dismissed. I have read and understood and agree to the provisions of this application form. If I am employed before the results of my police check are supplied to Pact I understand that my employment may be terminated if the police check reveals information that pact considers makes me unsuitable for the job or which contradicts statements I have made on my application. I understand that if I have supplied any false or deliberately misleading information, or if I have suppressed any material information, I may not be offered the position applied for, or if employed, my employment may be terminated.
Signature
*
Date
*
MM
DD
YYYY
Thank you for your application
Thank you!
