GORE MAIN SCHOOL

APPLICATION FOR EMPLOYMENT

 Important Notes for Applicants
Thank you for applying for a position with our school. Please ensure you have a copy of the
position description before completing this application.

1. Please fully complete this form personally. First, read it through, then answer all questions
and make sure you sign and date where indicated on the last page.
2. Attach a curriculum vitae (CV) containing any additional information, if necessary.
3. Copies only of qualification certificates should be attached. If successful in your application
you will be required to provide the originals as proof of qualifications.
4. If you are selected for an interview you may bring whānau/support people at your own
expense. Please advise if this is your intention.
5. Failure to complete this application and answer all questions truthfully may result in any
offer of employment being withdrawn or appointment being terminated, if any information is
later found to be false.
6. All applicants will be required to give consent to a Police vet.
7. a) Applicants may not be employed as a children’s worker if they have been convicted of a
specified offence listed in Schedule 2 of the Children’s Act 2014, unless they obtain an
exemption. The Criminal Records (Clean Slate) Act 2004 will not apply to these specified
offences and these offences will be included in your Police vetting results.
b) The Clean Slate Act provides certain convictions do not have to be disclosed providing:
• you have not committed any offence within 7 consecutive years of being
sentenced for the offence
• you did not serve a custodial sentence1 at any time
• the offence was neither a specified offence under the Clean Slate Act 2004 nor a
specified offence under the Children’s Act 2014
• you have paid any fines or costs
Please note that you are not obliged to disclose convictions if you meet the above conditions
but can do so if you wish. If you are uncertain as to whether you are eligible contact the
Ministry of Justice.
8. Shortlisted applicants being interviewed will need to provide originals of both a primary
identity document (e.g. passport) and a secondary identity document (e.g. New Zealand
driver license). A list of acceptable primary and secondary documents is available in the
last sections of the Children’s Regulations 2015.
9. This information will be held by the employer. For the successful candidate this document
will be held on their personal file, otherwise the information provided will be securely
destroyed after 90 days. You may access it in accordance with the provisions of the Privacy
Act 1993.
10. Your appointment to this position will be subject to police vetting. Please ensure all
information added is true and correct.

1
Custodial sentence means a sentence of imprisonment and includes corrective training, preventive detention, a sentence of
imprisonment served by home detention, borstal training, detention centre training and any other sentence that requires the full-time
detention of an individual. Non-custodial sentence includes, but is not limited to, a community-based sentence, a sentence of
home detention, a sentence of a fine or reparation, a suspended sentence of imprisonment, and a specified order.

2
 APPLICATION FOR EMPLOYMENT

Position applied for Location Vacancy/Reference Number

Full Name

First: Last:

Birth name (if applicable)

Are you known by any other name(s)? (if yes please provide below) Yes ☐ No ☐

Full postal address

Email address

Contact telephone numbers

Personal: Business:

3
Identity Verification, Criminal Record and Right to Work
Please tick the appropriate boxes:
Immigration information
Are you a New Zealand citizen? Yes ☐ No ☐

If not, do you have resident status, or Yes ☐ No ☐

A current work permit Yes ☐ No ☐

Have you ever had a criminal conviction? Yes ☐ No ☐

If “Yes” please detail:

(A board may not employ or engage a children’s worker who has been convicted of an offence specified in Schedule
2 of the Children’s Act 2014. The Clean Slate Act does not apply to schedule 2 offences.)
Have you ever received a police diversion for an offence? Yes ☐ No ☐

If “Yes”’ please detail:

Have you ever been discharged without conviction for an offence? Yes ☐ No ☐

If “Yes” please detail:

Do you have a current New Zealand driver’s licence? Yes ☐ No ☐

Have you ever been convicted of a driving offence which resulted in Yes ☐ No ☐
temporary or permanent loss of licence, or imprisonment?

If “Yes”’ please detail:

Are you awaiting sentencing or do you have charges pending? Yes ☐ No ☐

If “Yes”’ please state the nature of the conviction/cases pending:

In addition to other information provided are there any other factors Yes ☐ No ☐
that we should know to assess your suitability for appointment
and your ability to do the job?

If “Yes”, please detail:

Have you ever been the subject of any concerns involving child safety? Yes ☐ No ☐

If “Yes” please detail:

4
Are you aware of any injury or medical condition that could impact Yes ☐ No ☐
on your ability to perform this job effectively?

If “Yes”, please detail

For teaching/principal positions:

Do you hold a current practising certificate from the Teaching Council Yes ☐ No ☐
of Aotearoa New Zealand?

Please enter your registration number:

Educational Qualifications
Name Location Number of Highest
years Qualification
completed Gained

Secondary
School

University

Other

Employment History
Please list your work experience for the last five years beginning with your most recent position.
Please include months as well as years worked and explain any gaps in employment. If you
were self-employed, give details. Attach additional sheets if necessary.

Period worked Employer’s name Position held Reason for

leaving
(please specify the start and (or reason for gap
end dates) in employment)
Start date End date

to

to

to

to

5
Referees
Please provide the names of three people who could act as referees for you. One of these
should be your current or most recent employer. Please indicate which referee is your
current/previous employer in the table below.

Name Organisation Position/ Landline Mobile

Relationship (preferred)

I certify that:

● The information I have supplied in this application is true and correct.

● I confirm in terms of the Privacy Act 1993 that I have authorised access to referees.

● I know of no reason why I would not be suitable to work with children/young people.

● I understand that if I have supplied incorrect or misleading information, or have omitted any
important information, I may be disqualified from appointment, or if appointed, may be liable
to be dismissed.

Signature __________________________________ Date