Employment Application

Employment Application Form

In order to be considered for employment with Complex Chronic Illness, please complete and submit this application form. All information you provide is strictly confidential.
Please attach a cover letter, a curriculum vitae (CV) and copies of relevant qualifications.

Position applying for: *

Name *

First name

Last name

Address *

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Email address *

Phone *

Other phone

Ability to work

Are you a permanent resident of New Zealand? *

If NO, do you have a valid work permit?

Have you ever been convicted of any criminal offence? *

Note: CCI Support policy requires all staff to undertake a criminal check prior to employment.

Do you have any criminal charges pending? *

Have you been the subject of a professional disciplinary enquiry? *

Do you want to give further information about the above questions?

Do you have a full, current drivers license? *

Have you had any injury or medical condition caused by gradual process, disease, infection or other means – which the tasks of this job may aggravate? *

Note: CCI Support has a smoke free policy. Please be aware we do not discriminate on health reasons - we ask, so that we can look into how we can adapt the role to be more accommodating for you.

If Yes, please give further details

Why are you interested in joining our team? *

Qualifications & Professional Memberships

Please list any applicable to this role

Ability to start

If successful with this position, when is the earliest you'd be able to start? *

Declaration:

I declare that to the best of my knowledge the information provided in this application and in any resume enclosed is accurate and I understand that if any false or misleading information is given, or any material fact suppressed, I will not be employed, or if I am employed, my employment may be terminated.

I agree *

By submitting this form I am officially applying for this role and may be contacted by CCIS in relation to this application.

Cover Letter

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Curriculum Vitae

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Qualifications

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Supporting Documentation

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