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Application for Employment
The application form is a source of information which will be used by us to assist it in considering your suitability for the position which you are applying. If successful, such information shall form part of our personnel records. Failure to supply the information requested would prejudice our ability to assess your suitability for the position.
You may be requested to provide a pre-employment medical, if so any offer of employment is made subject to your completing this to our satisfaction.
You will also be asked to provide two forms of identification and to complete a NZ Police Vetting Services Request and Consent form. If you are from outside New Zealand or have been living abroad, you will also be asked to provide a police clearance from your country of previous residence. This will be at your expense.
You are entitled to access this information upon request to the company’s Human Resources Manager.
Unsuccessful applications will be retained by the company for a period of 12 months. The above information is provided in accordance with the Privacy Act 1993.
Along with your completed Application Form, please also provide copies of:
Your resume (CV)
A covering letter
CONFIDENTIAL – To be completed personally by Applicant
Note: The completion of this form does not indicate that there is any obligation on the Company to engage the applicant.
Purpose: This information is collected for the purpose of assessing your suitability for employment with SILC which may include subsequent changes in employment with the company. Please print clearly.
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Indicates required field
Date of Application
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Position Applied For
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Type of Employment
Ideally, how many hours per fortnight would you like to work?
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Your Name
Your preferred name
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Name
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First
Last
Are you known by any other name/s?
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Details of other names/s
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Contact Details
Address
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Line 1
Line 2
City
State
Zip Code
Country
Mobile
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Home
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Work
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Email
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Legal Work Status
Are you legally entitled to work in New Zealand?
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Yes
No
Choose Any
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As a NZ citizen
A permanent resident
A holder of a current work permit or Visa (please provide a copy with your application)
Education
Please indicate your highest level of qualification and provide details:
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School Certificate / Level 1
Sixth Form Certificate / Level 2
University Entrance / Level 3
NZQA Certificate in Health and Wellbeing
Level 2
Level 3
Level 4
Other relevant Qualifications
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Please provide a copy of your qualifications with your application.
Employment History
Your current or most recent position
Company
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Position Held
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Dates
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From: Month: Year: To: Month: Year:
Main Duties
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Hours Worked
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Reasons for Leaving?
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Your next most recent position
Company
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Position Held
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Dates
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From: Month: Year: To: Month: Year:
Main Duties
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Hours Worked
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Reasons for Leaving?
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Your next most recent position
Company
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Position Held
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Dates
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From: Month: Year: To: Month: Year:
Main Duties
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Hours Worked
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Reasons for Leaving?
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Work Experience
Have you ever worked for SILC or another organisation that provides support services to people with disabilities?
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Yes
No
If yes, who did you work for?
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Please outline the areas you have experience in supporting people.
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Have you supported people with medication before?
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Yes
No
Did you have any concerns doing this?
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Yes
No
If yes, what type of system did you use? (eg blister packs or medirolls)
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Do you have experience in other relevant areas such as caregiving or social services?
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Yes
No
If yes, please outline your experience below
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Secondary Employment
Do you have secondary employment?
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Yes
No
If yes, please provide details.
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Referees from your most recent Managers
Name
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Phone/s
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Organisation
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Email
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Relationship
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Commencement
If your application was successful when could you commence employment?
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Please provide a staring date
General
Do you have a spouse, partner or relative working here or elsewhere in the same industry?
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Yes
No
If yes, please provide details
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Are you prepared to do all tasks as outlined in the job description for the role you are applying for?
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Yes
No
If no, please provide details
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Supporting people to access their community is an important part of the support we provide. Are you prepared to support people to the following?
Church or place of worship
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Yes
No
Swimming (including being in the pool with the person you are supporting)
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Yes
No
Bars or Clubs
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Yes
No
Are there community activities you can think of that you would not be prepared to support someone to participate in?
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Some people we support require assistance with activities such as; having a shower, cleaning their teeth and using the toilet. Do you have any concerns with assisting a person in these areas?
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If you have any concerns please detail them below so that they can be discussed, should you be offered an interview.
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Other Skills
Do you have any experience in writing clear, brief and detailed reports?
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Yes
No
Would you have any difficulties with these tasks? If so, please note below so that this can be discussed at interview.
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What computer skills do you have and what programmes are you comfortable using?
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This role involves using our intranet. Are you comfortable using the internet?
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Yes
No
Rostered Shifts and Sleepovers
PLEASE NOTE: All staff are expected to do sleepovers, work every second weekend and rostered shifts
Are you prepared to work rostered shifts?
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Yes
No
Are you prepared to do sleepovers (sleeping at the home of the people You support?
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Yes
No
Are you prepared to work alternate weekends?
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Yes
No
Have you worked rostered shifts before?
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Yes
No
Have you worked sleepovers before?
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Yes
No
Have you worked weekends before?
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Yes
No
Criminal Convictions
Do you have any criminal convictions (including those covered under The Clean Slate Act)?
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Yes
No
If yes, please provide details
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First Aid
Do you have a current First Aid Certificate?
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Yes
No
If no, you will be required to gain an appropriate First Aid qualification as a condition of your employment. This will need to be completed within the first six months of your employment.
Driver License
Do you hold a current FULL New Zealand drivers licence?
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Yes
No
Drivers Licence No
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Do you have any demerit points or endorsements?
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Yes
No
If yes, what class(es)?
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If yes, please give details
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Do you have any traffic offence proceedings pending?
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Yes
No
If yes, please give details
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Important Note
: If you hold an
overseas drivers licence
, you must apply for and
obtain a full New Zealand drivers licence
before you will be offered employment with SILC.
Have you had experience driving
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Manual vehicles
Automatic vehicles
Mobility vans
Are you willing to drive any of the above vehicles as a part of your employment (this includes manuals)?
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Yes
No
Medical
If you are offered employment the offer may be subject to your obtaining a full medical clearance following the completion of our pre-employment medical.
Do you agree to undergo a medical examination if requested?
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Yes
No
Have you ever had or do you currently have
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Back Pain / Strain or Injury
OOS (or Repetitive Strain Injury)
Hearing Loss
Other Musculoskeletal problems
If you have answered to any of the above or have had any other medical condition caused by injury, gradual process, disease or infection that may be aggravated or made worse by this job please provide further information
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Have you claimed accident compensation in the last 12 months
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Yes
No
If yes, please provide details
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Do you have any health related issues (illness, disability, condition) that may impact on your ability to perform the tasks listed in the Job Description that you are applying for?
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Yes
No
If yes, please provide details
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The role of a support worker requires a high level of physical fitness as you will be required to support people in a variety of activities. This may include, but is not limited to; supporting people to move and transfer, walking for long periods etc. Do you have any concerns regarding the physical demands of the role?
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Yes
No
If so, please note these so they can be discussed at the interview
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Smokefree
As of the 31st of October 2015 SILC became a Smokefree organisation. This means that employees are not permitted to smoke while they are on shift or representing the company in anyway. Do you have any concerns about this?
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Yes
No
If yes, please detail them below so they can be discussed at interview
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Interests and Hobbies
What are your interests and hobbies?
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What other community interests do you have?
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What clubs or groups do you belong to?
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Declaration
Your Name
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full declare to the best of my knowledge the information supplied in this application and in any curriculum vitae provided is 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 also understand that any false information given in relation to my medical history with regards to gradual process, disease or infection can result in my loss of entitlement for any compensation from ACC. I further understand that any offer of employment may be subject to obtaining a full medical clearance through the company’s pre-employment medical.
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Yes
No
Consent
I consent to the company seeking verbal or written information on a confidential basis about me from representatives of my previous employers and / or referees and authorise the information sought to be released by them to the company for the purposes of ascertaining my suitability for the position for which I am applying. I understand that the information received by the Company is supplied in confidence as evaluative material and will not be disclosed to me.
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Yes
No
Upload File
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Max file size: 20MB
CV, Covering Letter, A copy of your Full NZ Driver Licence, A copy of either a Birth Certificate or Passport (further documentation may be required if these are not both in the same name eg a marriage certificate), a copy of your qualifications etc
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
Submit
Home
Who We Are
Meet our Clients
Our History
The SILC Charitable Trust
What we offer
Careers With SILC
Online Application Form
Contact
