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* 1. First Name

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* 2. Surname

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* 3. Please enter your home address:

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* 4. Home or mobile phone number (mobile preferred)

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* 5. Please enter your email address

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* 6. What role have you applied for?

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* 7. What is your legal work status?

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* 8. If you are on a work visa, when does this expire?

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* 9. Are you a smoker?

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* 10. Have you ever been convicted in NZ or any other country?

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* 11. Have you ever been imprisoned in NZ or any other country?

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* 12. Are there any charges against you yet to be heard?

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* 13. Have you ever been dismissed or been the subject of an investigation that resulted in your resignation?

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* 14. Please choose your current drivers license status:

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* 15. Have you made a claim to ACC or any other workplace insurer in the last 5 years?

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* 16. Do you or have you in the past had any back, neck or spine injuries or issues that may affect your ability to perform the job you are applying for?

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* 17. Have you ever suffered from Repetitive Strain Injury (RSI) or Occupational Overuse Syndrome (OOS)?

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* 18. Do you have any medical condition (mental or otherwise), disease or health issue that could impact on your ability to carry out the role that you are applying for?  This includes any allergies.

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* 19. If requested, do you agree to undergo one or more of the following either pre-employment or anytime during your employment with Superb Herb?
- Drug & Alcohol Test
- Criminal History Check
- Drivers License Check
- ACC History Check
- Full Medical Check

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* 20. Are you currently employed?

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* 21. If you are currently employed, how much notice do you have to give your current employer?

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* 22. Being a food producer, there are PPE and health requirements we must adhere to.  On that basis, are you comfortable working in an environment where you have to wear safety boots, a hair net (if you have long hair), a beard net (if you have a beard) a high vis vest, a face mask and not wear any accessories (including jewelery and any piercings), watches etc)?

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* 23. If you have any allergies to anything, please list these below

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* 24. Where did you see our job ad?

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* 25. What form of transport do you anticipate taking to work?

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* 26. For diversity data and reporting only (not selection processes) please choose your ethnicity below:

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* 27. Thank you for completing our Application for Employment form.  Please don't forget to hit the 'done' button at the bottom to ensure that this is submitted to us.  If you have any other comments or information you would like to give us, please put this in the text box below.  This information now forms part of your legal application with Superb Herb and by submitting this you are verifying that all information is true and accurate.  Thank you again for completing this and one of our team will be in contact with you soon.  Have a  great day!

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