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* 1. First Name

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* 2. Last Name

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* 3. What region are you currently living in?

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* 4. Date of Birth

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* 5. Email Address

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* 6. Contact Phone Number

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* 7. Are you available to work weekends?

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* 8. What position/s are you applying for?

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* 9. Are you a New Zealand Citizen?

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* 10. If no what is the type of Visa you currently hold?

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* 11. Do you have a current drivers licence of Restricted or higher?

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* 12. What relevent work experience do you have?

Do you suffer any of the following:

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* 13. Back trouble or limb injury?

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* 14. Fear of Heights (climbing ladders)

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* 15. Hand or wrist pain?

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* 16. Deafness or hearing problems?

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* 17. Persistent Cough, Bronchitis or Asthma? 

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* 18. Frequent Headaches

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* 19. Do you wear glasses

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* 20. Are you colour blind or have blurred vision

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* 21. Do you have allergies or hay fever

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* 22. Do you have dermatitis or exzema

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* 23. Do you have heart trouble or issues with blood pressure

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* 24. Do you have diabetes, tuberculosis or hepatitis 

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* 25. Do you suffer from blackouts or Epilepsy

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* 26. Do you have HIV or AIDS

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* 27. What is your Covid-19 Vaccination Status?

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* 28. Have you been on ACC for any work or non-work related injuries?

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* 29. Do you consent to an ACC Pre-employment Check being carried out? 

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* 30. For safety sensitive roles, you may be required to undergo a Pre-employment Drug & Alcohol Test. Do you consent? 

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