Full Name:

Email Address:

Do you live in New Zealand? Do you live in New Zealand? Yes No

Residential Address:

Phone Number:

Date of birth:

Position Applied For: Position Applied For: Skipper Engineer Deck Hand Mate

Date Available to start from:

1. How did you hear about the position?

2. Have you previously worked for Waikawa Fishing Company? 2. Have you previously worked for Waikawa Fishing Company? Yes No

Please state your reason/s for leaving below.

3. Do you hold any Maritime Qualifications? 3. Do you hold any Maritime Qualifications? Yes No

Please state your qualifications, also include if you have a valid Maritime Medical.

4. Are you employed at present? 4. Are you employed at present? Yes No

Please state who with & your reason/s for leaving? If not currently employed, why?

5. Please state a short summary of your previous employers/work experience and your reason for leaving your last position held?

6. Please state a short summary about yourself, relationship status, children, where you live etc.?

7. Have you ever had a conviction? 7. Have you ever had a conviction? Yes No

Please briefly explain.

8. Do you have any medical conditions the Company should be aware of? 8. Do you have any medical conditions the Company should be aware of? Yes No

Please state your medical conditions.

9. Are you willing to participate in a pre-employment drug test? 9. Are you willing to participate in a pre-employment drug test? Yes No

10. Please briefly explain what you hope to achieve with working for Waikawa Fishing Company? e.g. Why you have chosen to apply with us? Your wage expectation? If you wish to further your training etc.?

11. Lastly, please tell us why you believe you would be a good addition to our company?