Boulevard Services | Quick Quote

General

Name*

FirstLast

Address*

Street AddressAddress Line 2CityZIP / Postal Code

Email

Home Phone

Cellphone*

Date of Birth*

Position Applied for*

Education and Training

Secondary

Polytech/Tertiary

Qualifications Gained

(eg. School Cert/NCEA)

Interests/ Hobbies

Have you worked for a company similar to ours in any capacity?*

Yes
No

If yes when and where?

Do you hold a current New Zealand driver's licence?*

Yes
No

If yes, which one?

Full
Restricted
Learners

Please upload license copy

Do you have the right to legally work in New Zealand?*

Yes
No

Do you have the right of permanent residence or NZ work permit?*

Yes
No

When could you commence employment?*

Do you have any upcoming holidays/trips planned?*

Yes
No

If yes, when?

Employment Experience

Last/Present Employer

Position

Start Date

Finish Date

Key Responsibilities

Reason for Leaving

Previous Employer

Position

Start Date

Finish Date

Key Responsibilities

Reason for Leaving

Previous Employer

Position

Start Date

Finish Date

Key Responsibilities

Reason for Leaving

Referees

Please give name, company, position and phone number of at least 2 work related referees. We will require that you consent to Boulevard Services contacting referees in regard to reference checking.

Name

Phone Number

Company

Position

Name

Phone Number

Company

Position

Name

Phone Number

Company

Position

Reason for wanting to work at Boulevard Services?

Let us know why you would like to work with us.*

Medical Questionnaire

Do you have any medical conditions that may:

Affect your ablitity to perform your intended job?*

Yes
No

Be affected by the requirements of this position?*

Yes
No

Affect the health of other workers?*

Yes
No

Prevent you from carrying out the responsibilities of this position?*

Yes
No

If you answered yes please provide full details:

Are you taking and medication that may affect your ability to carry out the duties required for this position??*

Yes
No

If you answered yes please provide details:

Have you had any work related injury or illness that may affect your ability to do the job you have applied for?*

Yes
No

If you answered yes please provide details:

Have you previously made an ACC claim for an injury or illness that could be aggrevated by the type of work you are applying for?*

Yes
No

If you answered yes please provide details:

Would you not be able to wear any of the following if the work requires it:

If you answered yes to any of these please provide details:

Have you ever had a gradual process injury that may be aggrevated by the job you are applying for, e.g. occupational overuse syndrome / repetitive strain injury?*

Yes
No

If you selected any of the above safety wear please provide details:

Do you have arthritis, stiffness, pain, pins and needles or injury affecting the use of the following body parts?*

If you answered yes please provide details:

Have you ever had a back injury or operation?*

Yes
No

If you answered yes please provide details:

Do you have a history of:

Eczma
Any skin condition affecting you hands
Asthma

If you answered yes please provide details:

You may be working with heavy equiptment / machinery / at heights and or driving, please tick any of the following boxes if it applies to you.*

Have you had epilepsy or a seizure in the past?
Have you had an episode of loss of consciousness
Do you take medication that may affect your ability to concentrate
Do you have diabetes?
Do you have any known heart problems?
None of the above

If you answered yes please provide details:

Have you had any of the following problems in the past 3 months:*

Wheezing in the chest
Coughing at night
Shortness of breath when walking at a normail pace

If yes, have you , in the past 12 months:

Taken steriod / prednisone cream
Seen a doctor for your asthma
Been admitted to hospital

If you answered yes please provide details:

Criminal Convictions

Do you have any criminal convictions, not including any concealed under the Criminal Records (Clean Slate) Act?*

Yes
No

If you answered yes please provide details:

Do you have any civil legal proceedings against you pending?*

Yes
No

If you answered yes please provide details:

Have you ever been dismissed from employment for any reason or left employment for an reasons of your own dishonesty? *

Yes
No

If you answered yes please provide details:

Upload CV

Declaration*

I have read and fully understand this Declaration.

I declare that to the best of my knowledge the answers to to the questions in this application are correct and I understand that if any false information is given or any material fact suppressed, I may not be accepted, or if I am employed, I may be dismissed. I understand that any false information given in relation to my medical history may result in the loss of entitlement for any compensation in relation to subsequent work injury claim(s). I authorise you or your agent to contact the referees, persons, and previous employers and obtain information from them to be used in relation to my application for employment for the purposes of ascertaining my suitability for the position I am applying for. If the named referee or supervisor supplied is not authorised to speak on behalf of the company, if not available, enquiries can be made with the Manager or other duly authorised person. I understand that the information received by the company is supplied in confidence as evaluate material and will not be disclosed to me.

Apply Online

General

Education and Training

Employment Experience

Referees

Reason for wanting to work at Boulevard Services?

Medical Questionnaire

Criminal Convictions