Candidate interview form

Interview Form

The following is an interview form which you are requested to personally complete. The completion of this form does not indicate that there is any obligation on the employing Company to engage the applicant.

The interview form is a source of information which will be used by Scientific and Technical Recruitment Limited (STR) to assist in considering your suitability for the position for which you are applying. If successful, such information shall form part of the employing Company’s personnel records. Failure to supply the information requested would prejudice STR’s ability to assess your suitability for the position.

You are entitled to access this information upon request to the Company where information is held, provided it has not been deemed as evaluative and/or confidential. Information relating to unsuccessful applicants shall be retained by STR for a period of 12 months. The above information is requested in accordance with the Privacy Act 1993.

Today's Date*

Position Applying for:*

Your Contact Details

Your Name: (First / Last)*

Your preferred name:

Your address:*

Home Ph No.*

Mobile No.

e-Mail Address:*

General

Are you legally entitled to work in NZ?*

	Yes
	No

If yes; Are you a NZ Citizen?

	Yes
	No

or Are you a Permanent Resident of NZ?

	Yes
	No

or Do you have a NZ work permit?

	Yes
	No

If you have a work permit when does it expire?

Have you ever been convicted of a criminal offence?*

	No
	Yes

Are you awaiting the hearing of charges in civil or criminal court?

	No
	Yes

Do you have a current NZ driver licence?*

	Yes
	No

If No, Do you hold another country's driver licence?

	Yes
	No

If Yes, Which Country?

Do you have any demerit points or endorsements?*

	No
	Yes

If successful in your application, what period of notice would you be required to give your current employer?

	Less than 1 Week
	1 Week
	2 Weeks
	3 Weeks
	1 Month
	2 Months
	3 Months
	6 Months

What are your salary expectations?

Would you relocate within New Zealand? (ie: Move to any other part of NZ)

	Yes
	No

Have you previously been interviewed by Scientific and Technical Recruitment?

	Yes
	No

If yes, please state when, approximately.

Where did you learn about this vacancy or hear about our company?

	A Relative
	A Work Colleague
	A Friend
	From someone at STR
	STR's website
	Seek
	Search4jobs
	Working In
	Google
	Another Website
	OTHER

Are you currently actively seeking employment through any other recruitment agency?

	Yes
	No

If yes, please name

Do you have any personal situations or circumstances which may affect your ability to perform the job you are applying for either now or in the foreseeable future, including any scheduled or planned leave?

	Yes
	No

If yes, please describe

Do you have any injury, illness, physical disability, medical or psychological condition you have suffered that may affect your ability to effectively carry out the functions and responsibilities of the position applied for, or impact on the company, its business or staff?

	Yes
	No

If yes, please describe

Have you had an injury or medical condition caused by gradual process, disease or infection (for example, hearing loss, sensitivity to chemicals, occupational overuse syndrome) which the tasks of this job may aggravate or contribute to?

	Yes
	No

If yes, please describe

Do you agree to undergo a medical examination relevant to the job if required?*

	Yes
	No

Paste cover letter here*

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Paste your CV here*

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Consent & Declarations

(Full Name)*

consent to the Company seeking verbal or written information on a confidential basis about me from representatives of my previous employers and/or referees which I have nominated and authorise the information sought to be released by them for the purposes of ascertaining my suitability for the position for which I am applying.

If yes, (Signature)

Date Signed*

I,(Full Name)*

consent to Scientific & Technical Recruitment Limited transferring information to a potential employer by electronic means which includes but is not limited to fax, email, computer and Internet.

If yes, (Signature)

Date Signed*

I,(Full Name)*

declare that to the best of my knowledge the answers in this application are correct and I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I will not be accepted, or if I am employed, my employment will be terminated. (This declaration applies to all information provided on this form, or by resume, or by supporting documentation including written references and evidence of qualifications.)

If yes, (Signature)

Date Signed*