Leech & Partners Ltd Employment Application Form
(To be accompanied by full C.V. and Covering Letter)

Office
Ashburton
Christchurch
Position Applied For
Experienced Accountants
Graduates/Accounting Clerks
Administration/Payroll/Other
Personal Details
Surname
First Name(s)
Email Address
Home Address
Home Phone Number
Cellphone Number
Date of Birth
Are you a New Zealand Resident?	Yes  No
Are you a permanent Resident of New Zealand	Yes  No
Education
Tertiary Institution(s) attended. Add dates & Qualifications.
Are you studying currently?	Yes  No
Health
Do you have any impairment, physical or mental, that could effect your ability to do your work?
Have you had any prior injuries or accidents that would interfere with your ability to perform the job for which you have applied?
General Information
What are your recreational activities and hobbies?
Do you have any criminal convictions and/or prosecutions pending? Have you ever had a disciplinary action by a professional body?
Experience (relevant to position applied for).
Any other information or accomplishments you feel are relevant to this application

Application to Take Responsibility

 Agreement

I agree and accept that by undertaking certain tasks appointed by the Company that it does not constitute a job offer or the commencement of employment and I hereby accept that this is part of the job interview.

 Declaration

I declare

1. That my answers in this application are true and not misleading; and
2. That there is no further information that may be relevant that I have not told you about.

 I Acknowledge

1. That if you employ me you are relying on the truth and completeness of my answers and therefore;
2. That if in the Company’s opinion I have no answered truthfully and completely, you may terminate my employment immediately and without notice.

 I Understand

That false or incomplete answers relating to my medical history could mean that I man compromise my access and receipt of ACC compensation.

Name:
Date:

Please supply us your C.V. and Covering Letter

Please verify all responses are complete and accurate and that you have agreed to each section of the application to take responsibility.