Application For Employment Form

To apply for a position with Anexa Veterinary Services, please complete the form below.

This information is collected for the purpose of assessing your suitability for employment with the Anexa Veterinary Services. Failure to complete this form in its entirety may affect Anexa Veterinary Services ability to assess and continue with your application.

The information collected in this form will be handled confidentially and held in accordance with the Privacy Act 2020. The information will be shared with those directly involved in the recruitment process for the role you are applying for.

"*" indicates required fields

1. Legal name*
2. Residential Address*
5. Preferred contact*
Equal employment opportunities – Anexa Veterinary Services is an equal opportunities employer. Therefore, the information collected is used for statistical purposes to report on diversity of candidates. It is optional to supply this information.
Equal employment opportunities – Anexa Veterinary Services is an equal opportunities employer. Therefore, the information collected is used for statistical purposes to report on diversity of candidates. It is optional to supply this information.
11. Are you currently employed by Anexa Veterinary Services?*
12. Have you previously been employed by Anexa Veterinary Services?*
14. Have you ever been dismissed from any position?*
16. Do you have a current valid licence for driving in New Zealand?*
17. Driving entitlement?
Issue date for class 1
Issue date for class 1

Eligibility to work in New Zealand

23. Are you a current New Zealand Resident or Citizen?*
Please note that if you are successful through our recruitment process you will be required to provide verification of your eligibility.

Pre-Employment Checks

26. Have you been convicted of any criminal offence (excluding convictions under the Clean Slate Act), or are you currently being investigated by the police/serious fraud officer, or currently facing charges?*
(This includes drink driving convictions)
28. Do you consent to completing a Criminal Record Check if successful in securing a job offer with Anexa Veterinary Services?*
If you do not consent to a Criminal Record Check or meet satisfactory requirements for this, it may affect Anexa Veterinary Services’ s ability to continue with your job offer.

Health and Safety

Health and safety requirements: Declaration of a medical condition does not exclude candidates from equal employment opportunities with Anexa Veterinary Services unless it is a core criteria for the position; for example sight impairment for a role where driving is a core function.
29. Do you live with the effects of any illness, injury or condition (physical or psychological) that may impact on your ability to carry out the requirements of the position?*
30. Do you live with the effects of any illness, injury or condition (physical or psychological) that may be aggravated or further contributed to by tasks of the position?*
31. If you selected yes to questions 29 and/or 30, or if you are currently suffering; are there any special services or facilities which we could provide to enable you to carry out the work duties safely?
33. If successful in the role, do you consent to completing a pre-employment medical questionnaire as part of your onboarding into the role?*
If you do not consent to a pre-employment medical questionnaire or meet satisfactory requirements for this, it may affect Anexa Veterinary Services’ s ability to continue with your job offer.

COVID-19 Vaccination status

As part of Anexa’s response to COVID-19, we request potential candidate’s vaccination status for COVID-19. Vaccination status of potential candidates is held in accordance with the Privacy Act 2020 and is used for Anexa’s ongoing response to COVID-19.
34. Are you currently vaccinated against COVID-19?
36. Do you consent to supplying a copy of your vaccination certificate if required for Anexa's COVID-19 response?

Qualifications and Experience

Name
Organisation
Relationship
Phone
Email
Name
Organisation
Relationship
Phone
Email
40. Should you be in the final selection for a position, do you consent Anexa Veterinary Services to seek verbal or written information about you from your references provided and authorise the information collected to be released?*
41. Is there anything that you should declare to us that may prevent you from entering employment with Anexa Veterinary Services?*
43. Do you have any conflicts of interest to declare to Anexa Veterinary Services?*
Should you be successful in obtaining this role, this information will be held on your personal employee file.
45. If your application is unsuccessful on this occasion:*

Declaration

By completing this application for employment form, I confirm that the information given in this form is, to the best of my knowledge, true and complete.*
Any false statement may be sufficient cause for rejection, or if employed, dismissal.
Please type your legal name as form of electronic signature below:
MM slash DD slash YYYY
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