Application:

___ / ___ / ___

Interview:
___ / ___ / ___
Medical:
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Induction:
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Office Use
Only:

Application for Seasonal Employment (2010/2011)

This information is collected for the purpose of assessing your suitability for employment to a general factory,
forklift driving or harvester operating position with Heinz Watties NZ Ltd.
This form must be completed by the applicant and in readable print. Please complete all sections of the
application form, an incomplete form may mean your application is not able to be processed.

PERSONAL INFORMATION
Mr/ Mrs/ Miss/ Ms (Please circle one)

First Name(s): ...........................................................

Surname: ....................................

Other Name(s): ................................

Address:
........
Home Phone No: ................................... Other Phone No: .......................
(If you do not have your own phone, please include details of how you can be contacted by phone)

Email Address: ....

Country of Birth: ..
Are you legally entitled to work in New Zealand?

Yes

No

If yes, please select one of the following:

A. New Zealand or Australian citizen
B. Or permanent resident
C. Or hold a work permit

Yes
Yes
Yes Expiry / ...... / .

.
(Note: You need to attach a copy of your passport or birth certificate to verify this)

If your application is successful when could you commence employment? ............

If your application is successful when would you be available until? ......................
(E.g. returning to study, planned travel overseas)

Have you ever worked for this or another Heinz Watties Company? Yes
No
If yes, where? ................................................... Date held from .. / ..... / ... to .. / .. / ..
Role(s) held:
Have you applied for seasonal work at Heinz Wattie's before?
Yes
No
If yes, when and where? ..................................................................................................................
How did you hear about seasonal employment opportunities at Heinz Watties?
The Press
Current Employee Internet
Other (please state)

Do you know any person employed within Heinz Watties?

Yes

If yes, who? ............................................. What is their relationship to you?

.......................................

Application for Employment

Version 20/9/2010

No

Page 1 of 5

EDUCATION
Please name any qualification/s that you have gained or are currently completing:
(Including University, Polytechnic or any further training).
Name of Institution

From

To

Have you held any positions of responsibility?

Qualification

Yes

No

(E.g. team leader, voluntary work, etc)

........................................................................................................................
.
If yes, please detail:

EMPLOYMENT HISTORY
Are you presently employed?

Yes

No

If yes, what is the notice required by your employer? ..... days / weeks

Present or most recent employer:

Company:
.................................... Direct supervisor: .........................
Address:
..........................................................................
Position:
.................................... Date held from .. / ..... / ... to .. / .. / ..
Main duties:
............................................................................................
Reason for leaving: ........................................................................................
Next most recent employer:
Company:
.................................... Direct supervisor: .........................
Address:
..........................................................................
Position:
.................................... Date held from .. / ..... / ... to .. / .. / ..
Main duties:
............................................................................................
Reason for leaving: ........................................................................................
Next most recent employer:
Company:
.................................... Direct supervisor: .........................
Address:
..........................................................................
Position:
.................................... Date held from .. / ..... / ... to .. / .. / ..
Main duties:
............................................................................................
Reason for leaving: ........................................................................................
Give details of any other job that may be relevant: (E.g. Operating forklifts, harvesting, food industry)
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................

Application for Employment

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REFEREES
Please name at least two people who will provide work related references:
Name

Company

Telephone

Position Held

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 I
am applying for. I understand that the information received by the company is supplied in confidence
as evaluative material and will not be disclosed to me.
Yes
No

......................................................

...... / ...... / ......

(Signature)

(Date)

GENERAL
Are you applying for: Seasonal work
and / or Casual work

Yes
Yes

No
No

Note: Seasonal employees are engaged on a weekly basis, casual employees on an hourly basis

Are you applying for a forklift or harvester operating role?

Forklift Operating

Yes

If yes, you must complete an additional driving form (Page 5) and

attach it to this application.

No

Harvester Operating

Please tick which shifts you are prepared to work?

6am 2pm

2pm 10pm

10pm 6am

Yes

No

4 by 4

Any

Note: We cannot guarantee your work area or shift preference. It is also a condition of employment that you are
able to work in a shift pattern as circumstances require. Should you be unable to meet any request to change
shift, your employment may be terminated with notice.

Have you worked nightshift before?

Yes

No

Are you prepared to work overtime?

Yes

No

Yes

No

Will you engage in other paid work if employed by Heinz Watties? Yes
If yes, what is the role? .......................................... What are the hours? ..........
.....................

No

Note: this Includes weekends, Public Holidays, Christmas and New Years

Are you prepared to work as and where directed on site?

TRANSPORTATION
What transport arrangements do you have to attend work?
Driving Own Car

Reliant on a driver Specify

Other Specify ..

Yes

Do you have a current drivers license?

No

If yes, please tick valid classes / endorsements you hold on your license:

Car Learners Car Restricted Car Full

Class 2
W Endorsement F Endorsement

Osh Certificate Expiry ... / /

CRIMINAL CONVICTIONS
Have you been convicted of a criminal offence in the last 7 years? Yes
Application for Employment

Version 20/9/2010

No
Page 3 of 5

If yes, please detail: ........................................................................................................................

Are you awaiting the hearing of charges in a civil or criminal court? Yes
No
If yes, please detail: ........................................................................................................................
Have you ever been convicted of a serious criminal offence?
Yes
No
If yes, please detail: ........................................................................................................................
Note: Part of Heinz Watties process is to check your criminal history with the Ministry of Justice. Any
discrepancy between the information you supply and that obtained will be viewed as Serious Misconduct in a
formal discipline procedure and your employment will be in jeopardy.

MEDICAL
If you are offered employment, the offer is made subject to your obtaining a full medical clearance
following the completion of our pre-employment medical and the successful completion of our preemployment drug screening test. Heinz Watties is committed to a drug & alcohol free workplace.
Do you agree to undergo a medical examination and a pre-employment drug test?
Yes
No
Have you an injury or medical condition caused by gradual process, disease or infection for example
hearing loss, eye conditions, sensitivity to chemicals, repetitive strain injuries that may be
aggravated or further contributed to by the tasks of this job?
Yes
No

........................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
If yes, please detail:

In the last 12 months, how many days have you had away from work due to the following:
Sickness .Days

InjuryDays

Do you have a current First Aid Certificate?

Other LeaveDays
Yes

No

DECLARATION
I ..................................................................... (print full name) declare that to the best of my
knowledge the information supplied in this application and in any resume provided are 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 l am employed, my employment may 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 loss in my entitlement for any compensation from ACC. I
further understand that any offer of employment, if made, is conditional on my obtaining a full
medical clearance through the companys pre-employment medical.

......................................................
(Signature)

Application for Employment

...... / ...... / ......

(Date)

Version 20/9/2010

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Potential Forklift / Harvester Drivers

Applicants who wish to be considered for a forklift or harvester operating role must complete this form and
attach it to a completed application form.
If you are invited to attend an interview, you will be required to provide your original certificates and licenses for
verification purposes.

EXPERIENCE
Do you have forklift / harvester driving experience in a work environment?

Yes

No

..
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
If yes, please provide detail:

POTENTIAL FORKLIFT DRIVERS

Do you have a current Forklift Operator Certificate (OSH Certified trainer)?
If yes, please specify the date of expiry

Yes

No

Yes

No

/ /

Do you have F Endorsement on your drivers license?

All forklift operators will be required to undergo a pre-employment practical forklift driving
assessment prior to being offered employment at Heinz Watties.
Do you agree to undergo a pre-employment forklift driving assessment?

Yes

No

Do you have W Endorsement on your drivers license?

Yes

No

Do you have Full Class 2 on your drivers license?

Yes

No

POTENTIAL HARVESTER DRIVERS

DRIVERS LICENCE INFORMATION

Full Name:
Date of Birth: / / ...

Expiry Date: / / .. (4b on licence)

Licence Number: (5a on licence) . Version No: (5b. on license) ..

Classes: (7 on license) . Endorsements: (8 & 9 on license) ..
I authorise Heinz Watties to discuss any or all such personal details as well as the
assessment results to the following organisations: The Land & Transport Safety Authority
(LTSA) and its driver license Issuing Agents.
......................................................
(Signature)

Application for Employment

...... / ...... / ......

(Date)

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