Application Form - Burnsco Marine and Leisure

Company Information

Customer Information

Product Catalogue

Card Number

Surname

Remember me on this computer

If you don't know your card number please call 0800 10 20 41

Position applied for:
Location:
Where did you hear about this position?

Personal Details
First names:*
Surname:*
Preferred name:*
Home address:*
Postal address:*
Email address:
Home telephone:*
Cell phone:
Work telephone: (May we ring you there?)	YesNo
Date of birth:
Marital status:
Dependants:

General
Are you legally entitled to work in New Zealand?	YesNo
(Note: You may be required to produce evidence of your eligibility to work in NZ.)
Have you ever been convicted of a criminal offence?*	YesNo
If YES please give details
Are you currently before a court on a criminal matter?*	YesNo
If YES please give details
Are you able to work during peak trading times (October to January)?*	YesNo
Are you able to work weekends and public holidays?	YesNo

Medical
Do you have any illness or injury that might prevent you from performing at work?*	YesNo
If YES please give details
Have you ever suffered from an injury at work that required you to take time off?*	YesNo
If YES please give details
Do you smoke?	YesNo