Kiwi Can Do

Given Name: *

Family Name: *

Ethnicity*

Gender (M/F):*

Date of Birth:*

Name of friend/whānau who referred you:

Mobile: *

Permission to text: *

Landline

Address *

Email Address *

Do you have a current car Drivers’ Licence: *

If yes, Licence Number:

Do you have Photo ID (NZ Driver Licence or NZ Passport) *

Do you have a road legal vehicle: *

Do you have a current truck Drivers’ Licence:

If yes, categories of truck licence:

Do you hold any other type of licence?

Can you relocate for work *

Your Work & Income Office:

Case Manager:

Next of Kin (Emergency) full name

Kin Mobile

What is your highest level of education?

What training courses have you completed?

Health Details Do you have any medical, physical, intellectual, social, or behavioural needs or conditions that we need to know about? e.g. ADHD, asthma, depression, diabetes, epilepsy, high blood pressure, injury, illness, obesity, sight or hearing impediments. *

Explain Health Details "if NO, type "NO" or "N/A" *

Do you have any allergies? *

Allergy Details "if NO, type "NO" or "N/A" *

Criminal History (Answering ‘Yes’ to these questions will not necessarily stop you from attending) Have you ever appeared before any court on any charge? *

Details of criminal history "if NO, type "NO" or "N/A" *

Are you awaiting the hearing of a charge in any court? *

Hearing Details "if NO, type "NO" or "N/A" *

Are you currently serving any court imposed sentence or order? *

Sentence Details "if NO, type "NO" or "N/A" *

If you have answered ‘Yes’ to any of the questions above, please write your Probation Officer’s details below i.e. Their name and office "if NO, type "NO" or "N/A" *

Do you consent to MSD releasing to us, a copy of your Photo ID and CV? *

Do you agree to fill in a ‘Ministry of Justice’ Form on Orientation Day? *

Do you consent to a Pre-employment Drug Test? *

CADET INTERVIEW FORM