APPLICATION FOR EMPLOYMENT

POSITION APPLIED FOR: Produce Supervisor / Manager

WORK REQUIRED: FULL-TIME? Yes PART-TIME? No

PLEASE CIRCLE DAYS AVAILABLE: Mon Tues Wed Thurs Fri Sat Sun

FULL NAME: MD MAHBUBUL HABIB

Are you known by any other name? YES
If yes, by what name are you also known? SAIBAL

DATE OF BIRTH:01 JAN 1988 HOME PHONE NUMBER:0220775278

Required for purposes of Sale of Liquor Act and Minimum Wages Act.
EMAIL ADDRESS: [email protected]

ADDRESS: 1/50 Ely Street , City Centre , Christchurch 8013.

Are you legally entitled to work in New Zealand? YES
Passport Number: BM0421572 Visa Conditions: The Holder may work as Site Leader ( Retail Supervisor
621511) in Canterbury for any employer.
Nationality as show on passport:

I authorise the Company to obtain personal information regarding me, which is necessary for evaluation, my
suitability for employment. This may include the Justice Dept., Police, credit agencies, my claims history from
ACC etc.

Signed:___Mhsaibal_____________________________________________

EMPLOYMENT HISTORY: (Start with most recent position)

Employment date Employment date Position: Company: Reason for leaving:
from: to:
August 2015 Now Site Leader (Z Energy) Hattrick For better prospect
Services Ltd
December 2014 August 2015 CSR Jefkar Holdings Ltd For better prospect
March, 2010 June 2014 Executive Director Air Trip International Ltd Study Purpose

REFEREES:
Name: Address: Phone Number: Occupation:
Brent Terry Hattrick Services Ltd 0275599099 Ops Manager
Lisa Nahida Hattrick Services Ltd 02102356300 Manager
Abdulla Niyaz Royal Business College 02102209558 Director of Business Studies

EDUCATION HISTORY:
Date from: Date to: Qualifications: School / College:
July 2014 March 2015 Diploma in Business Royal Business College
Management Level 7
August 2007 July 2011 Bachelor of Business Southeast University,
Administration (BBA) Bangladesh
April 2004 July 2006 Higher Secondary Dhaka Commerce College,
Certificate examination Bangladesh

QUALIFICATIONS: (What professional or trade qualifications do you hold?)

 New Zealand Certificate Retail Level 4 and NZQF 2236

 St John First Aid Course
 Fire Extinguisher Course,
 Hattrick Leadership Course (HELP) powered by Ministry of Business, Innovation and employment

____________________________________________________________________________________
 Only to be completed if employment is offered.

Spouse or partners full name:________________________________________________

Emergency Contact:
Name:________________________________________________________________

Relationship:______________________ Ph number:___________________________

Address:___________________________________________________________________
MEDICAL – The Health and Safety in Employment Act requires us to ensure the safety of employees at work. Because
some tasks may aggravate a prior injury or disposition, please answer the following questions:

Have you, or have you had Yes No When Do you suffer from Yes No
An ACC claim for any injury  Earache, deafness 

TB  Skin infections 

Dermatitis or Eczema  High blood pressure 

Hernia  Heart complaint 

Back injury or strain  Diabetes 

Injury to limbs  Any allergies 

Blackouts or seizures  Colour blindness 

Are you taking drugs/medicines?  RSI 

Is there anything else we should know about, including health matters that may have an impact on your ability to perform
any roles that you are applying for?
no

GENERAL:
Yes No
Have you previously been employed by a Four Square, New World or Pak n Save store? 

Do you object to enquiries being made of your past or present employers? 

Are you prepared to work Saturdays? 

Are you prepared to work Sundays? 

Are you prepared to work as and where directed? 

Are you prepared to abide by safety and work rules?

Have you ever been convicted of a criminal offence? If yes, give brief details 
…………………………………………………………………………………………………………………………
….
Are you awaiting the hearing of criminal charges? If yes, give brief details 
…………………………………………………………………………………………………………………………
…..
How many days absence have you claimed during your last 12 months of employment? 3 days ...............
Do you have a current driving licence? If yes, what class? Class 1 , full 

Have you ever submitted a personal grievance claim to an employer? 

Have you ever been subject to an investigation for dishonesty or violence by a previous employer? 

Do you have any known condition that may put yourself and other staff at risk? 

Have you ever been dismissed for any reason, including redundancy? 
If your application is accepted, when could you commence employment? 3 – 4 weeks
If your application is accepted, what would be your intended length of employment? Long term

DECLARATION:
I, MD MAHBUBUL HABIB declare that to the best of my knowledge, the answers to the questions in this application are correct and I
understand that if any false information is given, or any material fact suppressed, I may not be accepted, or if I am employed, I may be
dismissed. If offered employment, I understand I am required to serve a probationary period of 90 days or 12 weeks during which my
performance shall be assessed.

I authorize the Company to approach previous employers to gain additional information with regard to my past employment
performance.

I also understand that the information requested is required to assist in determining suitability for employment with …Tekapo Services ..
and should I gain a position the additional information required will be supplied to form the basis of any personal record. I understand
that I am entitled to have access to relevant information retained by……Tekapo Services…….. except for any exemption provided under
the Privacy Act 1993 such as evaluative material.

The information supplied is to be dealt with in accordance with the Privacy Act 1993.

SIGNATURE:_____________MHSAIBAL___________________________ DATE:____________2017-09-10______________

ADDITIONAL INFORMATION: Do you have any additional information, which you consider might assist your application? For example
achievements, interests, aspirations etc? If so, please attach additional information to the application form.