Application Details*I amApplying for an Advertised PositionSubmitting an Expression of InterestPosition applied for*State the advertised position clearlyName* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Mobile PhoneEmail LandlineCriminal Offence*Have you been convicted of a criminal offence or do you have any charges pending (excluding any minor traffic offences):YesNoIf yes, please give brief details:Criminal Record Check*I agree to undergo a Criminal Record CheckI do not agreeLegal Working Status*Are you legally entitled to work in New ZealandYesNoMedicalIf you are offered employment, the offer may be subject to you obtaining a full medical clearance following the completion of our pre-employment medical. I agree to undergo a Pre-Empoyment Medical I agree to Pre-Employment Drug and Alcohol testing Injury or Illness*Have you had any injury or medical condition caused by gradual process, disease or infection for example hearing loss, sensitivity to chemicals, occupational overuse syndromeYesNoIf yes, please specify details and your last date of treatment for (each of) the injury(s) or illness (es)*Will the tasks of this position further aggravated or contributed to your injury or illnessYesNoDriver's Licence*Do you have a current licenceYesNoIndicate for what classes 1 - Car licence 2 - Medium rigid vehicle licence 3 - Medium combination vehicle licence 4 - Heavy rigid vehicle licence 5 - Heavy combination vehicle licence 6 - Motorcycle licence W - Wheels Endorsement T - Tracks Endorsement R - Rollers Endorsement D - Dangerous Goods Endorsement Education and QualificationsList your qualificationCurriculum VitaeUpload your CV here Drop files here or Accepted file types: pdf, jpg, gif, png, docx, doc. Relevant Experience*List your most recent experience firstCompanyRoleDutiesHrs per weekYear fromYear to Referees / Reference*Please provide the details of at least two referees who we can contact.Name and SurnameCompanyRelationshipTelephone # Declaration*I declare that to the best of my knowledge the answers in this application for employment form 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. I further understand that any offer of employment if made maybe conditional on my obtaining a full medical clearance through the Company’s pre-employment medical. I also understand that the information requested within this application form is sought to establish my suitability for the position that I am applying and that if I do not provide such information then this application for employment may be rejected. If I am unsuccessful I DO / DO NOT authorise Westroads to maintain this application on their files for future opportunities for a period of one year.Yes - I agreeNo - I do not agreeEmailThis field is for validation purposes and should be left unchanged.