Heritage Curator

PERSONAL INFORMATION UNDER THE PRIVACY ACT 1993 


The information provided on this form will be used to process your application. The information requested is not required by Law, but if insufficient information is provided your application may not be considered. 

People having direct access to this information include the hiring manager, members of the interview panel, and the Executive Assistant. Under the Privacy Act 1993, you have a right of access to personal information about you held by Te Manawa and you are also entitled to request information about you to be corrected. This information will be securely held in Te Manawa files for a maximum period of twelve months from the time an appointment is made, after which time it will be destroyed, unless you are the appointee in which case the information will be placed on your Personnel file. 
NOTE: Completion of this form does not indicate any commitment to employ you.

REFERENCES

I consent to Te Manawa 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 TM for the purposes of ascertaining my suitability for the position for which I am applying. I understand that the information received by TM is supplied in confidence as evaluative material and will not be disclosed to me.

DECLARATION

I declare that 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 relevant material withheld, 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.

1. Yes I agree to the privacy statement*

1. Title* Mr Mrs Ms Miss Dr Other
2. First name*
3. Last name*

1. E-mail*
2. Phone*

   Digits only or add + for international numbers

1. Street*
2. Street Cont.
3. City, Town or Suburb*
4. Postcode or Zipcode*
5. Country*Please choose... AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE INTERNATIONAL OTHER Unknown
6. State, Region or Province*Please choose...

1. Gender Male Female Non-binary / Non-conforming Prefer not to say

1. LinkedIn URL

   (Please click on your profile and copy the URL from your profile page.)

1. Do you speak or read any languages other than English? *

   1. Yes
   2. No
2. If yes, please explain:
3. Te Manawa as part of its commitment to the Treaty of Waitangi invites short-listed applicants to bring whanau support to their interview. If you are invited to an interview, do you wish to bring whanau support?*

   1. Yes
   2. No
4. If yes, approximately how many people (to ensure there is adequate space):
5. Are you a New Zealand Citizen?*

   1. Yes
   2. No
6. If you answered No to the question above, do you have either of the following:
   
   Please ensure that you can provide evidence. The visa in your passport is the best option to show evidence of your entitlement to work. If your visa was issued online, include your letter or email from Immigration New Zealand to show this.

   1. NZ Resident or Permanent Resident Visa
   2. A Visa to Work in New Zealand
   3. Neither
7. If you cannot work in New Zealand indefinitely, please explain your circumstances:
8. I agree that the information I provide can be used to confirm my work entitlement and identity:*

   1. I agree
   2. I do not agree
9. What is your salary expectations?*

   1. <10,000 PA
   2. 10-20,000 PA
   3. 20-30,000 PA
   4. 30-40,000 PA
   5. 40-50,000 PA
   6. 50-60,000 PA
   7. 60-70,000 PA
   8. 70-80,000 PA
   9. >80,000 PA
10. Do you have a current driver’s licence?
    *

    1. Yes
    2. No
11. What class(es)?
    Any endorsements? Please specify:
12. Have you been convicted of any offence in the last ten (10) years (including driving offences)
    (not concealed under the Criminal Records (Clean Slate) Act 2004)?*

    1. Yes
    2. No
13. If yes, please explain:
14. Are you awaiting the hearing of charges in a civil or criminal court of law?*

    1. Yes
    2. No
15. If yes, please explain:
16. Are there any other previous employment matters such as disciplinaries or dismissals that could have a bearing on your employment?*

    1. Yes
    2. No
17. If yes, please explain:
18. Do you have commitments which may prevent you attending your place of employment now or into the future, or that may affect your availability for overtime / out of hours work?*

    1. Yes
    2. No
19. If yes, please explain:
20. If offered this position, do you intend to engage in other paid employment?*

    1. Yes
    2. No
21. If yes, please explain:
22. If offered this position, when could you reasonably start?*
23. Have you had an injury or illness, or have a condition that may affect your ability to perform the duties of this job, or which may be aggravated by this job?*

    1. Yes
    2. No
24. If yes, please explain:
25. Do you require any alterations or additions to your work area in order to be able to perform your duties satisfactorily?*

    1. Yes
    2. No
26. If yes, please explain:
27. Te Manawa has a strict smoke-free policy, including in the buildings and grounds, and at any time while on Te Manawa business. Please indicate if this is going to be an issue for you.*

    1. Yes
    2. No
28. Please supply the name of at least three people whom we can contact as part of your application. At least two of these referees should be people you have reported directly to.
    NB: We will only contact your referees if you are our preferred candidate.*