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PicknPlay NZ Recruitment Application

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YOUR DETAILS

TITLE

SURNAME

FIRST NAME

ADDRESS

EMAIL ADDRESS

PHONE

MOBILE

CAN YOU RECEIVE TEXTS?

Yes

Intended method of transport while in NZ

Do you hold an International Driving License?

Yes

When is it valid until?

Have you been convicted of any criminal offences in the last 7 years for which a custodial sentence was imposed?

Yes

If yes, please give details

YOUR WORK STATUS

Do you have a current New Zealand Work Permit?

Yes

You will be required to produce documentary evidence

Enter Visa Number

Enter Visa Expiry Date

YOUR AVAILABILITY

Start

Finish

Mark in this box the dates you are available

Are there any dates in this period you will be unavailable to work?

Please mark below the days you are available (preference will be given to those with the greatest flexibility)

MONDAY		FRIDAY
TUESDAY		SATURDAY
WEDNESDAY		SUNDAY
THURSDAY

WORK EXPERIENCE

Have you been employed in the Horticultural Industry?

Yes

If yes, what type of work?

Have you ever supervised people (at work, a club, a team)?

If yes, what was the activity?

Please show the last 2 employers you have worked for longer than 1 month

Last Job	Date From
	Date To
	Company
	Location
	Role
	Supervisor/Manager
	Contact Phone No
	Email

2nd to Last Job	Date From
	Date To
	Company
	Location
	Role
	Supervisor/Manager
	Contact Phone No
	Email

MEDICAL HISTORY

Have you had any injuries that have stopped you from working?

Yes

If yes, please provide details of injury and how long you were off work

Do you have any medical history or condition?

Yes

If yes, please explain nature of condition

Are you presently taking any prescription or non-prescription medication?

Yes

If yes, please provide details

Are you under medical supervision?

Yes

If yes, please provide details

Are you aware of any health reasons that would prevent you from working in certain work environments?

Yes

If yes, please provide details

How did you hear about Adecco Pick"n"Play?

Do you require assistance in finding suitable accommodation while you are in New Zealand?

To help us in suggesting a Work/Play program for you
List 5 must do activities	List 5 must see places