Deep Sea Career Application

First Name

Last Name

Phone

Mobile Phone

Date of Birth

Please provide your current address

Position applying for

Are you legally entitled to work in New Zealand?

Have you ever worked for Talley's previously

If yes, when and where

Have you worked on a fishing vessel before?

Yes

Have you ever been convicted of any offence as per the Criminal Records Act 2004 or currently awaiting charges? (excluding any speeding fines, tickets and/or parking offences)

Yes

Do you consent for Talley’s Ltd to conduct a criminal record check with the Ministry of Justice?

Yes

If YES - Have you been known by any other names? (Please give details)

Are you aware of any factors that would place you in a potential conflict of interest with Talleys?

Yes

Do you have any health issues i.e physical impairment, injuries or mental conditions which may be considered for your ability to perform in the role, or affect your work attendance?

Yes

Maybe

If answered yes or maybe please give a brief description of the condition and how it is managed.

If successful in your application, when are you able to start work?

Please attach your CV

Cover letter

I declare that to the best of my knowledge the answers given in this application are correct. I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I may not be employed or if employed I may be dismissed. I consent to Talley’s seeking verbal or written information about me on a confidential basis from the referees I have nominated, and authorize the information requested to be released. I understand that the information will be supplied in confidence as evaluative material and will not be disclosed to me. I have disclosed any illness or injury which I believe might affect my capacity to undertake the duties typical of this industry and I agree to undergo a physical examination if requested. I understand and agree that if my application is successful, the information will be used as a base line to measure any future exposure to work hazards and for health monitoring purposes. Further, I agree to relevant aspects of my medical records to be viewed in order to assist Talley’s to meet compliance obligations. I also understand that any false information given in this application may result in my loss of entitlement for any compensation from ACC, and the Company declining to accept any claim.