Active Institute

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Active Institute

Employment Preparation and Placement Programme - Online Enrollment Form and Information for your CV

Email *

All information gathered will remain private and confidential.

Name *

First and last name

Home Address *

Phone number *

Alternative Contact Phone Number

Gender *

Female

Male

Other

I'd rather not specify

Date of Birth (dd/mm/yyyy) *

What is your ethnicity? *

What is your residency status? *

Do you have a driving licence? *

Have you access to a computer and the internet? *

Do you have a current CV? *

Yes

Which industry do you want to work in? *

Aged Care

Security

Building & Construction

Hospitality & Retail

Contact Centre & Administration

Road Transport, Warehousing & Logistics

Other

Required

If other, which industry?

Type of work required?

Full time

Part Time

Type of role?

Key work skills (tick all that apply) *

Ability to accept and learn from constructive criticism

Reliability, flexibility and dependable team member

Cooperative and adaptable person who also follows rules

Proven good attendance record

Ability to read and follow instructions

Commitment to continued training and learning

Willingness to take instruction and responsibility

Willingness to be a good worker and to go beyond to achieve targets

Resourceful and able to creatively solve problems that arise

Adapt to new situations and challenges

Work well under pressure or stressful situations

Strong communication skills (ability to listen, write and speak effectively)

Other:

Required

List any other skills you have that you feel are relevant:

Employment History

Please list the last 3 company's you worked for including the name and location of the company, the time (month/year to month/year) you worked there, your position and your duties. Please start with your last job first.

Company 1) Name of Company, Location and time (month/year to month/year) you worked there

Company 1) Position and duties

Company 2) Name of Company, Location and time (month/year to month/year) you worked there

Company 2) Position and duties

Company 3) Name of Company, Location and time (month/year to month/year) you worked there

Company 3) Position and duties

Please list 2 referees and their contact details

What is the name of the school you last attended?

What year did you leave school?

What level of education have you achieved in New Zealand? *

Secondary School

Private Training Establishment (PTE)

Polytechnic

University

Apprenticeship

Other:

What is your highest qualification?

What is your Work and Income New Zealand client number? *

What benefit are you receiving from Work and Income New Zealand? *

Job Seeker

Sole Parent

Supported Living

Disability

Other:

Is English your first language?

Yes

Clear selection

If English is not your first language please specify.

How long have you worked? *

Full time work for one year or more

Full time work for less than a year

Part time work only

Never worked in paid employment

Do you have any computer experience? *

Beginner

Intermediate

Advanced

None at all

What current certificates or licences do you currently hold? eg Forkhoist, First Aid, Welding *

Are there any issues that might affect your chances of gaining employment? *

Health Issues

Literacy and Numeracy Issues

Family / Childcare

Criminal Record

No Issues

Other:

Required

Please tick all that apply *

I would pass a drug test

I would pass a security check

I can work part-time (20 hours per week)

I can work full-time (30 hours per week)

I can do shift work

I can work weekends

I have my own reliable transport

I rely on public transport

I am taking medications

Required

If you ticked "I am taking medications" please list the medications you are currently taking

How would you liked to be contacted? *

Phone

By ticking this box I declare to the best of my knowledge that all information entered into this form is true and correct.

Required

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