Dentalwellness Centre Employment Application Form

This information is collected for the purpose of assessing your suitability for employment at Dental Wellness Centre. If selected this information will be kept on file. It may be accessed and corrected by you, the employee. If your application is unsuccessful you may request the return of your application.

The enclosed Job Description outlines the key competencies and key result areas for this position.

Please complete this Application for Employment. A Cover letter and Curriculum Vitae must be uploaded with this application.

Which position are you applying?*

Dental AssistantTrainee/Internship

Are you legally entitled to work in New Zealand?*

YesNo

If you are legally entitled to work because you have a VISA, please indicate the TYPE of Visa you have when that VISA will expire

Visa Type & Expiry Date

Thank you for your interest to join us.

Unfortunately, you must have the legal right to work in New Zealand to be eligible for this role.

Full Name*

First NameLast Name

Birth Date

MonthDayYear

Phone Number

E-mail Address:*

Address:*

Street Address

Street Address Line 2

CitySuburb

Zip CodeCountry

Driver's Licence*

Yes/No | Type of Licence and Expiry Date

Upload CV:

Upload a File

Upload Cover Letter:

Upload a File

Typing speed and accuracy is an essential skill to your success in this role. This is not compulsory but completing a typing test can help us determine your suitability for the role. You can complete a 3 minute typing test by heading to typing.com then upload a screenshot of your certificate below.

Browse Files

Upload file

Do you have a current (within 2 years from today) First Aid/ Basic Life Support Certificate?*

YesNo

Upload your First Aid/ Basic Life Support Certificate

Browse Files

Upload file

CONFLICT OF INTEREST

Do you work for, or provide services to, any other competing practice or organisation?*

YesNo

Please provide details:*

CRIMINAL & BANKRUPTCY HISTORY

Have you been convicted of a criminal offence, or are you presently awaiting court proceedings for any criminal offences outside of the criteria in Section 7 of the Criminal Records (Clean Slate) Act 2004?*

YesNo

If YES, please provide brief details:*

Do you consent to undergoing a criminal record check?*

YesNo

Your role may require police safety checking under the Vulnerable Children's Act 2014. You will have to complete a separate consent form to complete this process. Do you agree?*

YesNo

If you are an overseas applicant can you provide police certification from your country of citizenship and any other country you have lived in for over a year in the past ten years?*

YesNo

Have you ever been declared bankrupt or convicted on any charge of dishonesty?*

YesNo

HEALTH SCREENING

Do you have Hepatitis B immunity or Completed your Hepatitis B Vaccinations?*

YesNo

If yes, please enclose laboratory result and/or vaccination report(s)

Browse Files

DISABILITIES / MEDICAL CONDITIONS

Are you suffering from or been in contact with any diseases that may pose a risk of infection to others? e.g. COVID-19, MDRO, Hepatitis A, B or C, HIV/AIDS.*

YesNo

If YES, give details including types and dates*

Do you have any disability, medical condition, or suffer from anything that may affect your ability to perform or effectively carry out the tasks and responsibilities for the the role which you have applied (for example OOS, back injury, stress related illness)? If Yes please provide details*

YesNo

If Yes please provide details (please include details of any services or facilities which would allow you to carry out this role satisfactorily)*

Please note:

The Human Rights Act 1993 defines disability as: physical disability or impairment; physical illness, psychiatric illness; intellectual or psychological disability or impairment; the presence in the body of organisms capable of causing illness; any other loss or abnormality of a body or mind function; and reliance on a guide dog, wheelchair or other remedial means.

Declaration and Acknowledgement

This information is being collected to enable Dental Wellness Centre to assess your suitability for this position and will be used for this purpose only. If you fail or refuse to provide the information requested, then your application may be rejected. If you provide false or inaccurate information, this will be considered serious misconduct and may result in instant dismissal should you be employed by us. Please also note that any false information given in Section 7, titled Disabilities or Medical Conditions, may result in your loss of entitlement to compensation from ACC/health and disability insurance.

The Privacy Act 1993 provides you with the right to request access to and/or correct the personal information about you held by Dental Wellness Centre.

Ifull name* declare that the information I have given, whether oral or in writing (including information provided in my curriculum vitae) is correct and I understand that if I have given false or misleading information or have knowingly omitted important information, I may be disqualified from further consideration or, if appointed, may be liable to dismissal.

Signature

Date Completed*

DayMonthYear

Dental Wellness Employment Application