EmailMeForm
Apex Care Screening & Application for Employment
Thank you for applying for a position with Apex Care. Once we receive your application, please know that we'll be in touch soon.
Being an agency, please note that our contracts are mainly casual. Also, we do not sponsor work visa applicants.
We look forward to receiving your application.
Name
*
First
Last
Email
*
Date of Birth
*
MM
/
DD
/
YYYY
Phone
*
Today's Date
*
DD
/
MM
/
YYYY
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Emergency contact
First
Last
Emergency contact PH:
Region you want to work in?
*
Waikato
Bay of Plenty
Northland
Auckland
Taranaki
Manawatu
Whanganui
Wellington
Please define which town within the Region above
*
Do you have previous experience working in the health/mental health or social service sector?
*
Yes
No
Do you have previous experience working with youth?
*
Yes
No
Do you have a current New Zealand drivers licence?
*
Yes
No
What type of licence do you hold?
*
Learners
Restricted
Full
I do not hold a licence
Do you have your own vehicle?
*
Yes
No
Are you a NZ Citizen or Resident?
*
Yes
No
Hold a work permit, on visitor visa
None of the above
If required would you agree to a drug/alcohol test?
*
Yes
No
Have you had any criminal convictions or faced charges in the last 7 years?
*
Yes
No
Are you aware of any medical conditions or infectious diseases that you have that could be passed onto Apex Care clients?
*
Yes
No
Are there any aspects of your health you feel should be revealed to ensure your safety at work?
*
Yes
No
If yes, please provide details
Are you prepared to handle all products, materials, or equipment used in the industry?
*
Yes
No
Qualifications Held and Year Completed
*
Please list any qualifications you hold or enter "none".
We are particularly interested in qualifications in the health, education or social sectors
Do you have a current First Aid Certificate.
*
Yes
No
Please note that this is a required certification for the role. If you don't have one, please know that you'll need to gain this as part of coming on board with Apex Care.
Please explain why you are right for this position?
Employment History (last 5 years)
*
Company
Position Held
Date from - to
Most Recent Role
Next Most Recent
Next Most Recent
Next Most Recent
References: Employers or Supervisors we can contact. These must be within the last year. If you have worked in the health sector, the references should come from there.
*
Name
Company
Position Held
Phone Number
Email Address
Second Reference
*
Name
Company
Position Held
Phone Number
Email Address
If employed, when can you start?
*
Availability - Please mark the days and times you are usually available
AM
PM
Night
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other Employment - Please list below any other employment you will be continuing with whilst working for Apex Care
Declaration
- I declare that the above information I have given is true and correct
- I understand this application does not guarantee me work
- In accordance with the privacy laws, I allow Apex Care permission to contact the verbal references I have provided
- I hereby confirm I am entitled to work in NZ
- I hereby confirm I have disclosed all my criminal
convictions, charges or impending charges.
*
Clear
Please sign above