Old MacDonald's

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please tick all of those that apply:

I have the legal right to work in New Zealand

I am an NZ resident

I hold a work permit

I have secondary employment

I am awaiting the hearing of charges in a criminal court of law

Do you have/had any medical injuries or illness' that may be aggravated or further contributed to by the tasks of this job?

Yes

No

Declaration:

I declare that my answers in this application are not misleading and are true

I declare that there is no further relevant information that needs to be disclosed

I acknowledge that if Old MacDonald's employs me then they are relying on the truth and completeness of my answers and therefore if I have not answered truthfully, Old MacDonald's may withdrawal any offer of employment of terminate employment without notice