Temporary Employment/Contractor Application Form - Crescent

Name*

First Name Last Name

Phone*

Email*

Address*

Street Address Suburb City Country

Emergency Contact*

First Name Last Name

Relationship with emergency contact?

Emergency Contact Phone*

Are you a New Zealand Citizen, Permanent Resident or Australian Citizen?*

Yes
No

Please provide a copy of your NZ drivers licence or passport.*

We require proof of identification for a Ministry of Justice Criminal Record Check.

Max. file size: 250 MB.

Please provide a copy of your Work Visa*

Drop files here or

Accepted file types: pdf, doc, docx, pages, txt, rtf, Max. file size: 250 MB, Max. files: 2.

Please provide a copy of your Passport*

Drop files here or

Accepted file types: pdf, doc, docx, pages, txt, rtf, Max. file size: 250 MB, Max. files: 2.

What type of contract work or temporary role are you seeking?

Available from:

Are there any days/times you are unavailable?

Do you have a vehicle?

Yes
No

References

Please provide the details of two people you have directly reported to in previous positions and who we can contact for a verbal reference. Please note they will not be contacted without your permission.

Referee #1

First Name Last Name

Referee #1 - Job Title and Company*

Job Title Company

Referee #1 - Phone

Referee #1 - Email

Referee #2

First Name Last Name

Referee #2 - Job Title and Company*

Job Title Company

Referee #2 - Phone

Referee #2 - Email

Health & Safety / Medical History

Do you have any medical conditions which may affect your ability to perform the role for which you are applying?*

Yes
No

Please provide details of medical conditions*

Are you currently receiving any medical treatment and/or medication?*

Yes
No

Please provide details:*

Are you allergic to, or have any sensitivity to any substances or chemicals?*

Yes
No

Please provide details:*

Do you have a medical condition that may require emergency treatment?*

Yes
No

Please provide details:*

Are you suffering from or have been in contact with any diseases that may pose a risk of infection to others (e.g. TB, Hepatitis B or blood-borne viral conditions)?*

Yes
No

Please provide details:*

Are you suffering from any injury or medical condition which could place you at risk whilst carrying out the type of job you are applying for?*

Yes
No

Please provide details:*

Pre-employment checks

Do you agree to undertake a pre-employment medical examination and/or drug test, if required by potential employers?*

Yes
No

Have you ever been convicted of any criminal charges/offences or civil claims?*

Yes
No

Please provide details of criminal charges/offences or civil claims.*

Please note you are not required to disclose previous convictions only if the Criminal Records (Clean Slate) Act 2004 applies to you. View the Criminal Records (Clean Slate) Act 2004 here and seek independent advice, if you are unsure.

Payroll Details

Employment Type:*

Temporary worker receiving wages as an employee of Crescent Consulting
Self-Employed Contractor - no registered company
Contractor - with registered company

Company Name:*

Are you GST registered?*

Yes
No

GST Number:*

Please upload completed IR330C (Tax rate notification for contractors) Form*

Please download the IR330C form from here.

Max. file size: 250 MB.

Please upload completed Tax Code Declaration Form*

Please download the Tax code declaration form from here.

Max. file size: 250 MB.

Are you between the age of 18 and 65?*

Yes
No

Please upload completed Kiwisaver Deduction Form*

Please download the KiwiSaver deduction form from here.

Max. file size: 250 MB.

Bank:*

Branch:*

Bank Account Name:*

Bank Account Number:*

Privacy Consent Disclosure and Declaration

I declare that all of the information I have provided to Crescent Consulting is true, accurate and complete.
I understand that Crescent Consulting may need to collect additional information, including but not limited to a criminal, credit and medical history, work experience and performance history, qualifications and aptitude test results and opinions of other parties, including referees, and hereby authorise you to collect such additional information.
I authorise you to disclose all personal information provided by me and any additional information that you collect to persons who have a legitimate basis for receiving the information, including:

Any potential or actual employer and clients of Crescent Consulting
Referees

I acknowledge that in the event my personal information is disclosed to any other person that you will procure an acknowledgement by that person that they will only use the information for the purpose for which it is provided and that that person will comply with obligations in relation to personal information created under the Privacy Act.
This declaration and authorisation is made on the basis that you will only collect information that is necessary for the proper performance of your tasks and functions and that any personal information collected will not be used for any unlawful purpose, that it will be stored securely and retained only for as long as is necessary to enable you to undertake those tasks and obligations. I acknowledge that all payroll information will be retained for a statutory period of at least 7 years.
I acknowledge that all personal information provided by me and any additional information obtained by you will be relied upon to determine my suitability for employment or appointment to a position and in the event that you establish that any such information is untrue, inaccurate or incomplete, Crescent will be entitled to withdraw an offer of employment or terminate any employment relationship.

Declaration*

I agree to the privacy consent disclosure and declaration.*

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