Application Form

To apply for a role at CPIT please complete the online application form below and attach the following documents:

Covering letter
Curriculum vitae

CPIT as a member of the EEO trust is committed to equality and diversity and makes a determined effort to develop an inclusive environment to achieve a balanced gender representation and increase the number of Maori and other under represented groups on staff. We are an active provider of opportunities for differently abled people and recognise that all staff, are not only our employees, but have multi faceted lives that from time to time may require flexibility from CPIT to assist in meeting their other commitments.

Please view our web pages for more information on the recruitment process and working at CPIT.

Any queries should be directed to the HR Division Tel. 940 8623.

Please Note: All fields marked with an Asterisk are mandatory

1. Personal Information

Vacancy:	911134 :
Job Description:
Family Name: *
First Name: *
Second Name:
Third Name:
Preferred Name:
Title: *
Gender:	Statistical purposes only
Date Of Birth:	Statistical purposes only dd/mm/yyyy

2. Primary Address

Home Street Address 1: *
Street Address 2:
Suburb/Town: *
City/ Town:
Postcode:
Country:

3. Postal Address

Postal Street Address 1:
Street Address 2:
Suburb/Town:
City/ Town:
Postcode:
Country:

4. Contact Information

Home Phone#: *
Work Phone#:
Mobile:
Fax:
Email Address:*
Internal Applicant:

5. Residency Status

Note for non-New Zealand residents: Any offer of employment will be subject to confirmation of your legal entitlement to work in New Zealand.
Are you a NZ Citizen, Australian Citizen or NZ Permanent Resident *
If NO do you have a current permit with conditions permitting this employment?
Visa Type:
Visa Expiry Date:	dd/mm/yyyy

6. Recruitment Information

Recruitment Source:

7. Employment History with CPIT

Have you previously worked for CPIT? *

Yes

1.2. If Yes, please provide approximate dates and under what name.

8. Referees

Please provide full details - name, address, contact number/s, email, work relationship e.g. former supervisor - for two referees who may be approached for a confidential statement regarding your suitability for this position. Referees should be able to give work related information and should have supervised or been senior to you.

Referee 1 *

Referee 2

9. Qualifications and Teaching Experience

If you are applying for a TEACHING position with CPIT please answer ALL questions in this section.

For non teaching roles, please complete question 10.1.

10.1. Do you have a qualification relevant to this position?

Yes

If Yes, please provide details - title of qualification, name of institution, year achieved, number of full time years study.

10.2 Do you have a teaching qualification?

Yes

10.3 Do you have teaching experience?

Yes

If Yes, please indicate the number of full time years of teaching experience you have completed.

Does your teaching experience include specific experience teaching adults?

Yes

If Yes, please indicate the number of full time years of specific adult teaching experience you have completed.

10. Criminal Convictions Disclosure

CPIT requires you to disclose all convictions unless they are covered by the Criminal Records (Clean Slate) Act 2004. If you would like more information on what disclosure is required, please contact the Human Resources Division at CPIT.
You must declare all of your convictions if you have -

been convicted of an offence within the last 7 years OR
been sentenced to a custodial sentence (eg imprisonment, corrective training, borstal) OR
been ordered by a Court during a criminal case to be detained in a hospital due to your mental condition, instead of being sentenced OR
been convicted of a "special offence" (eg sexual offending against children and young people or the mentally ill.)

Note - The declaration of an offence does not disqualify from consideration for appointment. However, the non-declaration of an offence that you are required to disclose will be seen as a misrepresentation of a criminal record. Please ensure that you detail convictions that are required to be disclosed.

Please answer the following question based on the above criteria. Tick one box only: *

Yes, at least one of above criteria applies and I will disclose my criminal convictions below

No, none of the above criteria applies to me or I have no convictions to disclose

If you have indicated Yes to the above question, please provide detail below.

11. Kiwisaver Information (pursuant to the Kiwisaver Act 2006)

Are you currently a Kiwisaver member?

Yes

If Yes, are you currently on an approved Contributions Holiday?

Yes

12. Occupational Health and Disability

Do you consider yourself to have a disability?

Yes

If Yes, please describe in general terms and what assistance may be necessary for you if appointed

Have you had an injury or medical condition which may have arisen from illness, accident, gradual progression e.g. hearing loss, occupational overuse syndrome, sensitivity to chemicals or back problems - which the tasks of this position may aggravate or which could affect your ability to carry out this role?

Yes

If Yes, please provide details.

13. EEO Information (for statistics purposes only)

Ethnicity:

14. Attached Documents

Attachments: A CV and covering letter are mandatory. Acceptable formats: doc and pdf.
Document Type	File Name
Covering letter
Curriculum Vitae
Reference

15. Declaration All information on this form is confidential and will be retained by the Human Resources Division of CPIT for six months. If appointed to a position information will be retained on your personal file. By submitting this application I declare that the information I have supplied in this application form and in my CV is true and correct. Providing false or incomplete information could be grounds for non-appointment or termination of appointment. I declare the information is correct

16. Submission

Please Enter the text in the following image below