REGISTER


General Registration




Personal Details


Current Address




Primary Contact Number



Secondary Contact Number



Other Details Yes No
Yes No

Source Information

Highest Level of Academic Qualifications Please enter details of your highest level of education.








Second Highest Level of Academic Qualifications Please enter details of your second highest level of education.








Professional Certification Please list certifications you hold that are most relevant to the position you are applying for.





 
Employment History How many years work experience do you have working in a similar role / comparable position?


Current/Most Recent Job






Second Current Most Recent Job






Third Current Most Recent Job






 
Current Application
Heavy (>50%)          Light (<25%)
  Moderate (25-50%)  No


Yes No
Availability Status
Yes No

Yes No
The following information is required to assist the Greymouth Group to meet its obligations under the Health and Safety in Employment Act 1992 and its Amendments, and the Injury Prevention, Rehabilitation and Compensation Act 2001. Yes No


Please describe any particular supports that would be needed to accommodate your
specific health and safety requirements, this may include technical aids, equipment or
adaptations to the work environment.

Clearance Details Confirmation of the appointment of the successful applicant will be subject to the completion of a satisfactory medical clearance, including a drug and alcohol test.

Other than under the provisions of the Criminal Records (Clean Slate) Act 2004, have you been convicted of a criminal offence? Please check your rights on disclosure under the Criminal Records (Clean Slate) Act 2004 before answering this question.

Yes No
Yes No
Yes No

Yes No
Yes No

References Please provide details of two people who can supply a reference for you. These people should be able to provide work related information and should have directly managed or supervised you.














 
Your Resume

Upload Your Resume*:

Please enter the full path of the file you wish to upload, or click "Browse" to find the file. Only Microsoft Word documents with extension *.doc & *.docx, Adobe Acrobat PDF with extension *.pdf and HTML documents with extension *.HTML are allowed.

The personal data you provide is for potential employment and otherwise as part of the recruitment process, and will be held and processed for the purpose of your registration, applications and the selection processes of the Greymouth Group and in connection with any subsequent employment or placement, unless otherwise indicated. The personal data supplied by you will be initially controlled by or on behalf of the Greymouth Group. The information will be retained only for as long as is permitted by local legislation and then destroyed. In order to process the personal data provided and otherwise for the purposes indicated, your personal data may be disclosed to other Greymouth companies and to third party organisations providing administration or other relevant services to the appropriate company in the Greymouth Group.

The personal data provided and otherwise may be transferred to the Greymouth Group or related companies or third party organisations. The relevant company in the Greymouth Group will try to ensure that your personal data is protected in accordance with the applicable law. By submitting your personal data and application you (1) declare that you have read, understood and accepted the statements set out in this information integrity form (2) are declaring that you have not omitted any material fact/s and that the information given in this form is true and correct to the best of your knowledge; and (3) are giving your consent to the processing of the information contained in this application or subsequent applications, and any other personal data you may provide separately in the manner and to the extent described in this form; and (4) are authorising the relevant company in the Greymouth Group to verify or have verified on their behalf all statements contained in this application form and to make any necessary reference checks and (5) understand and accept that providing false or incomplete information will result in your application being discontinued.


   



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