Application Form
(All fields are required)
1. Advertising Avenue:
Where did you see this position advertised?
2. Eligibility:
Do you have the legal right to work in New Zealand?
3. Residency Status:
Which of the following best describes your current residency status?
4. Area of interest:
What area of DIALOG Fitzroy are you interested in working in?
5. Area of work:
If you selected other in the previous question, please detail which other aspect of the business you would like to be involved in:
6. Location :
Which DIALOG Fitzroy location are you interested in working from?
7. Work Availability:
Please select the option that best fits your availability
8. Former DIALOG Fitzroy Employee:
Have you been previously employed by DIALOG Fitzroy or Fitzroy Engineering Group as either an employee or a contractor?
9. Drivers Licence:
Please indicate all classes of full New Zealand Drivers Licence that you hold.
10. Medical :
Do you, or have you ever suffered from any medical, mental or physical condition that may affect your ability to perform the functions or responsibilities of the position you are applying for?
11. Medical:
If yes to the above question please provide details below. If no please write N/A.
12. Accident Compensation:
Have you claimed accident compensation in the last 12 months? No/Yes - if yes, please give details
13. Vaccination Status:
Please advise of your COVID Vaccination Status:
14. Criminal Convictions:
Have you ever been convicted of a criminal offence that would affect your ability to do this role?
15. Criminal Convictions:
If yes to the above question please provide details below. If no please write N/A.
16. Criminal:
Do you have or are you waiting for criminal charges to go before the court?
17. Justice Department Check:
Should you be offered employment do you authorise DIALOG Fitzroy to obtain a copy of your personal information held on you by the Justice Department?
18. Declaration - Testing:
I accept that prior to the commencement of employment I will be required to have a satisfactory physical capacity assessment, pre-employment medical and a drug and alcohol test.
19. Declaration - Documentation:
I accept that prior to the commencement of employment I will be required to supply the original documents pertaining to stated qualifications/certificates for DIALOG Fitzroy to certify, a current drivers licence, passport or a birth certificate and a copy of a current NZ work permit, if applicable.
20. Declaration :
I declare that to the best of my knowledge the information I have provided on this form is true and correct. I understand that if any false information has been given or any material fact is withheld, I will not be accepted for employment, or if I am employed, I will be dismissed. I understand that any personal information provided will be used according to the NZ Privacy Act 2020 and may be held for up to 12 months.
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