Application for Employment – International

Applicant Instructions:

If you need assistance completing this application or for any phase of the employment process, please please contact our human resources department and every effort will be made to accommodate your needs.

Complete this application in full.
If more space is needed to complete any question, please use the Comments section.
Answer clearly. Incomplete applications will not be processed.
Provide only requested information. Failure to do so may result in disqualification of your application.

Your Details:

Last Name:

First Name:

Middle Initial:

Desired Position

Location

Where did you see this position advertised?

Email address:

Home Phone:

Cell Phone:

Address:

Address 2:

City:

Post Town:

Postal code:

Date You Can Start:

Drivers License:

Do you hold a current full driving license?

Details of any endorsements and dates:

Do you own a car?

Do you have any unspent convictions?

No
Yes (please describe)

Do you have any relatives working for the company? If so, please list the names, occupations, and locations.

Have you ever previously worked for the company? If so please list the dates, occupation, and location.:

Comments:

Previous Employers:

If you have additional relevant work history, complete as many of the following as needed.:

Present/Most Recent Employer:

Company Name:

Address:

City:

Job Title:

Company Phone Number (Area Code First):

Dates Employed:

Duties:

Wage/Salary Per:

Reason for Leaving:

Notice required

Previous Employer:

Company Name:

Address:

City:

Post Town:

Job Title:

Dates Employed:

Wage/Salary Per:

Reason for Leaving:

Previous Employer:

Company Name:

Address:

City:

Post Town:

Job Title:

Dates Employed:

Wage/Salary Per:

Reason for Leaving:

Previous Employer:

Company Name:

Address:

City:

Post Town:

Job Title:

Dates Employed:

Wage/Salary Per:

Reason for Leaving:

Previous Employer:

Company Name:

Address:

City:

Post Town:

Job Title:

Dates Employed:

Wage/Salary Per:

Reason for Leaving:

Previous Employer:

Company Name:

Address:

City:

Post Town:

Job Title:

Dates Employed:

Wage/Salary Per:

Reason for Leaving:

Previous Employer:

Company Name:

Address:

City:

Post Town:

Job Title:

Dates Employed:

Wage/Salary Per:

Reason for Leaving:

Education:

School Name:

Location:

Qualifications/Grades:

School Name:

Location:

Qualifications/Grades:

School Name:

Location:

Qualifications/Grades:

School Name:

Location:

Qualifications/Grades:

List any skills, licenses, certificates, or training courses that may be related or of value to this job or company.

Health:

Have you visited your Doctor/Specialist in the last 12 months?

No
Yes (please describe)

Are there any disabilities which may affect your application?

No
Yes (please describe)

Do you require any adjustments?

No
Yes (please describe)

Are you currently receiving treatment for any medical conditions?

No
Yes (please describe)

We are an equal opportunities employer.

Please answer all of the following questions as accurately as possible.

Have you ever had treatment for any of the following? If you answer "yes" to any question, please provide details and dates below.

Bronchitis/ Asthma/ Pneumonia/ Pleurisy/ TB?

No
Yes (please describe)

Heart Trouble/ Shortness of Breath/ Angina?

No
Yes (please describe)

Back problems/ Lumbago/ Slipped disc/ Sciatica?

No
Yes (please describe)

Fits/Fainting Attacks/ Epilepsy?

No
Yes (please describe)

Diabetes?

No
Yes (please describe)

Skin Problems/ Dermatitis/ Eczema?

No
Yes (please describe)

Problems with Hands, Wrists, Arms or Shoulders e.g. Tenosynovitis/ Frozen shoulder or Upper Limb Disorder?

No
Yes (please describe)

Any allergies?

Have you ever been dismissed or had to give up another job for medical reasons?

Do you smoke?

I understand and accept that further medical information may be requested from my doctor if considered necessary and subject to the occupational health advisor obtaining my consent under the Access to Medical Reports Act 1988.

References:

Please provide two references we can contact:

Name:

Address:

Phone:

Relationship:

Name:

Address:

Phone:

Relationship:

Other:

What other hobbies/interests do you have?

Any other information

Next of kin

Relationship

Address

Attach Resume:

Please attach your resume. Attachments must be in pdf format and cannot exceed 4 MB. If your documents do not meet these requirements, you may send a hard copy via traditional postal services to the address listed below.

Attach a file by dropping it in here. You can also [browse your computer]

Your browser does not support HTML5 uploads. Please update to a newer version.

Certification & Release:

I UNDERSTAND THAT THE EMPLOYMENT SHALL BE SUBJECT TO:

• The terms and conditions of the Employment Rights Act 1996 (as amended)
• Satisfactory references being obtained from previous employers
• My agreement not to own, keep or attend on behalf of another, or be associated in any other way with live domestic poultry, game birds, pet or captive birds (including budgies, canaries, etc.)

 I declare that all the foregoing statements are true to the best of my knowledge and that by withholding any medical information which later comes to light may disqualify me from employment and render me liable for dismissal.  

I understand that any false declaration or misleading statement or any significant omission may disqualify me from employment.  

I agree to adhere to the above conditions.

Yes, I agree

Date:

Aviagen

Application for Employment – International

Applicant Instructions:

Your Details:

Drivers License:

Previous Employers:

If you have additional relevant work history, complete as many of the following as needed.:

Present/Most Recent Employer:

Previous Employer:

Previous Employer:

Previous Employer:

Previous Employer:

Previous Employer:

Previous Employer:

Education:

Health:

We are an equal opportunities employer.

Please answer all of the following questions as accurately as possible.

Have you ever had treatment for any of the following? If you answer "yes" to any question, please provide details and dates below.

References:

Please provide two references we can contact:

Other:

Attach Resume:

Oh no!

Certification & Release: