Application Form
(All fields are required)
1. Advertising avenue:
Where did you see this role advertised?
2. Residency status:
Which option best describes your current residency status?
3. Immigration Check:
Part of our employment process is to undertake an immigration check. Do you give consent for this?
4. Conflict of Interest:
If offered this position, will you be voluntarily engaged in any other employment/position that may cause a conflict of interest with CCS Disability Action? If so, please outline below.
5. Police Check:
Part of our employment process is to undertake a full police check, and appointment is subject to a satisfactory outcome. Do you give consent for this?
6. Criminal Convictions:
Do you have any criminal convictions including any concealed under the Criminal Records (Clean slate) Act? If yes, please detail below.
7. Drivers Licence:
Do you have a current full NZ drivers licence?
8. Demerit Points / Endorsements:
Do you have any demerit points / endorsements?
9. Medical Conditions / Injuries:
Under the Health and Safety at Work Act 2015, we must ask. Do you suffer from or have you suffered any injury or medical condition, that may impact you doing this job?
10. Medical Conditions / Injuries :
Are there any specific supports, equipment or assistance that CCS Disability Action can provide to allow you to perform this job? If yes, please detail.
11. Information Obtained:
Do you give consent for CCS Disability Action to use your information to assess your suitability for other position vacancies that may arise within the next 6 months?
12. Salary:
Please indicate what salary you are looking for?
13. Sector Experience:
Please describe your experience in the disability sector / community?
14. Appeal:
Please outline why this position appeals to you and why we should consider you for this positon.
15. Experience:
How many years teaching experience do you have?
16. Experience:
Do you have a diploma/degree or similar in Early Childhood Education?
17. Experience:
Do you hold a current Teachers registration?
18. Experience:
Do you have a Diploma in Early Intervention?
19. Experience:
Please indicate which documents you have knowledge of
20. Availability:
If offered the role, when will you be able to commence employment?
21. Declaration:
Do you consent to CCS Disability Action seeking verbal or written information from the referees? I hereby certify that all the information given for my application is complete, true and correct.
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