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APPLICATION FOR EMPLOYMENT ~ TE TONO KIA WHIWHI MAHI
The completion of this form does not indicate there is an obligation on Bay of Plenty District Health Board to engage the applicant. This information is collected for the purpose of assessing your suitability for employment at Bay of Plenty District Health Board, which if employed, may include subsequent changes in your employment with Bay of Plenty District Health Board.
Please note, if short-listed for an interview, evidence of entitlement to work in New Zealand will be required from both New Zealand citizens and non-New Zealanders in accordance with the Immigration Act (2009).

Declaration
I declare that to the best of my knowledge the answers provided in this application form and any other information provided to Bay of Plenty District Health Board in support of my application is correct and I understand that if any false or deliberate misleading information is given, or any material suppressed, I will not be accepted, or if I am employed, my employment may be terminated. I also understand that any false information given in relation to my medical history with regard to gradual process, disease or infection can result in my loss of entitlement to any accident compensation.

Police Vetting Consent:
The outcome of the police vet and safety check will not otherwise be shared with any person or organisation except as permitted by law and will be dealt with in accordance with the Privacy Act 1993.

It is our policy that police vetting (NZ Police Vetting Service) or Criminal Convictions History (Ministry of Justice) checks will be completed for all preferred candidates as a pre-condition of employment. Will you consent to the District Health Board (DHB) undertaking a check? (Failure to provide consent to the DHB will prevent your application from progressing further).

It is our policy to ask if you have ever been convicted for, are currently being charged with, under investigation, or awaiting to appear in court for a criminal offence.

NOTE: You are not required to disclose any convictions that are eligible to conceal under the provisions of the Criminal Records (Clean Slate) Act 2004. It is your responsibility to determine if you are eligible to conceal any conviction. To find if you may be eligible please go to this website:
http://www.legislation.govt.nz/act/public/2004/0036/latest/DLM280840.html

Data Retention Declaration -
The information that you provide to Bay of Plenty District Health Board (BOPDHB) is used for recruitment purposes. Bay of Plenty DHB staff involved in the recruitment process will be given access to this information.

We keep your information for the time period required to complete the purposes for which it is processed or satisfy legal retention requirements. The length of time for which we retain information depends on the purposes for which we collected and use it or the requirements of the applicable laws. If our processing of your data is covered by European data protection law (GDPR - General Data Protection Regulation), you have certain rights including: -

You can request access and review information your information at any time
You have a right to correct your personal data
You can ask that we stop using your information
You have the right to request that your information is erased
You have the right to withdraw consent

We undertake to keep your information safe to the best of our ability by maintaining the integrity/security of systems on which your data is kept. If you have any questions about our dealings regarding your Personal Information including any breaches by us of any privacy laws or any questions regarding this Privacy Statement you are able to submit that complaint or query by contacting us at recruitment@bopdhb.govt.nz

Any complaints received by us will be referred to Human Resources and a response will be provided to you as soon as possible.

For more information about privacy issues in New Zealand and protecting your privacy, visit the New Zealand Privacy Commissioner's website.

By my Accepting below, I certify that I have read, fully understand and accept all terms of the foregoing statement.

EU Residents Statement
For candidates from the European Union who are applying for positions or creating profiles through this platform we must explicitly seek your explicit approval to store your personal data for an undetermined, but appropriate, period of time in order to meet the European Union General Data Protection Regulation (EU GDPR). By accepting the terms of this full privacy statement, you are also agreeing specifically to our storing your personal data in line with the European Union General Data Protection Regulation (EU GDPR).

To assist you in successfully completing your application please allow approximately 15 to 20 minutes - also ensure that you have all of the mandatory documents ready to attach, you can scroll through the application form to read what is required to support your application prior to starting.

Good luck with your application.

Please indicate how you heard about this job

Please enter details*

Do you have New Zealand citizenship or permanent residency?

Yes

Do you currently work for BOP DHB

Yes

*Have you previously worked for BOP DHB

Yes

*For external candidates only. Have you worked in the Public Service or for a statutory Crown entity employer previously?

Yes

For external candidates only. Do you consent to the disclosure to the BOPDHB of whether you have been subject to a serious misconduct investigation, either concluded and upheld or currently under investigation, from all previous Public Service and statutory Crown entity employers for the last three years?*

Yes, I consent
No, I do not consent
I would like to discuss this before it is undertaken

Do you have any relatives, members of your household or friends already employed by the Bay of Plenty District Health Board with whom you maybe working in close association with if you are appointed to the position applied for? *

Yes

For statistical reporting purposes we are asking you to answer the following question.
This information is NOT used in the evaluation of your application.

Please would you state which ethnic group you best identify with? (You must answer this option but you may choose not to reveal your ethnicity if you wish)
Note: An ethnic group or ethnicity is a category of people who identify with each other based on common language, ancestral, social, cultural. or national experiences

What is your ethnicity? *

Gender *

Have you lived in any country other than New Zealand for more than 12 months in the last 5 years?

Yes

Have you ever been convicted in court for an offence? *

Yes

Note: All successful candidates will be required to undergo New Zealand Police clearance.
This clearance is subject to the Criminal Records (Clean Slate) Act 2004 and may be subject to the exception contained in section 19(3)(e) of the Criminal Records (Clean Slate) Act 2004.

Are you awaiting court charges? (Including Driving or Traffic Convicitions) *

Yes

Do you have a current full NZ Driving Licence? *

Yes

Do you smoke? *

Yes

Do you have any form of disability that may enhance the diversity of our workforce? *

Yes

In Progress

Do you have a current Practicing Certificate?*

Yes

Are there any limitations or pending charges to your scope of practice?*

Yes

Have you been subject to professional or other disciplinary inquiry or have knowledge of an event that might give rise to disciplinary inquiry*

Yes

If you are a nurse:
Do you have a PDRP / QLP portfolio?

Yes

Not Applicable

Education Qualifications

Country

Qualification

Year of Completion

List the names and contact details of at least three professional referees you authorise us to contact to obtain referee reports. At least two of your referees should work within your speciality, one of these referee’s must be from your current or most recent line manager.

Name

Surname

Position

Organisation

Phone

Mobile

Name

Surname

Position

Organisation

Phone

Mobile

Name

Surname

Position

Organisation

Phone

Mobile

By supplying the names of these people in confidence to the Bay of Plenty District Health Board we will:

Assume that you have advised and given these referees your permission for them to disclose information about you to Bay of Plenty District Health Board.
Seek information from these referees on the basis that the referees will supply the information in confidence as evaluative material for the purposes of the Privacy Act 1993 and that any information supplied by the referee will not be disclosed to you should you request to access to it.

Note: These obligations of confidence are subject to any requirement Bay of Plenty District Health Board has under the Official Information Act 1982, to disclose the information to you.

Curriculum Vitae and Cover Letter

Please attach your most up to date Curriculum Vitae and Cover Letter to support your application.
(Each attachment can be a maximum size of 2MB)

Curriculum Vitae*

Cover letter (Optional)

Please note that your application will not be able to be submitted prior to including the attachments.

Additional Attachments

(Previous DHB Certificate Of Service, Visa, Practising Certificate, Written Reference, Indemnity Insurance, Resuscitation Certificate etc)

The additional attachments are not mandatory, you can provide documents to the DHB at a later date should your application be successful.

Attachment 1

Attachment 2

Attachment 3

Attachment 4

Attachment 5