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H2R Declaration Form

* First Name(s)

* Surname

* Email

* Mobile

Street Address

Suburb

State

Post Code

* What best describes your working rights in NZ?

* Do you hold a NZ Drivers Licence?

* Do you have any traffic related offences, convictions or charges pending?

If yes please detail:

Have you ever been convicted of any criminal offence against the law or do you have any criminal charges pending excluding those offences that you are not required to disclose pursuant to the CriminalRecords (Clean Slate) Act 2004?

IF yes please detail:

Do you have any medical conditions, injury (including RSI,OOS, mental health) or substance dependency that could affect your ability to undertake, or be aggravated by, the role that you have applied for, or your employment in general?

If yes please detail any conditions that may be aggravated by particular working environments:

* Have you ever been the subject of any investigation, disciplinary action, written warning, or dismissal process by a past or current employer?

If Yes please detail:

* Is all the information you have provided to H2R Holdings Ltd true and accurate in every way?

* Have you omitted any information which would affect an employer’s decision to employ you?

* In the final stages of potential employment, do you authorise H2R Holdings Ltd to contact third parties to conduct credit, medical, qualification, traffic conviction, Visa and criminal conviction background checks where appropriate, and to provide this information to its clients?

* Do you authorise H2R Holdings Ltd to contact referees nominated by you in writing and to provide this information to its clients?

Declaration: H2R Holdings Ltd includes its subsidiaries, H2R Consulting, H2R Technology and H2R Pty Limited. The information which you submit to H2R Holdings Ltd (including all forms of psychological assessment, skills and aptitude testing, and your CV) will be used to ascertain your suitability for all forms of employment. However, we will not release this information to clients further without your consent. On successful placement into any position, this information may be later used by your employing body to ascertain your suitability for promotion (if relevant) or other positions (if relevant).

H2R Holdings Ltd may, at its discretion, appoint an appropriate person or agency to make reasonable enquiries to ascertain the veracity of any information provided to H2R Holdings Ltd as to your qualifications or character. We will retain all information for future vacancies (permanent or contract) and may transfer information to our associated consulting companies worldwide. Should you wish H2R Holdings Group to delete the information from H2R Holdings Group’s database, we shall require written notification to do so.

I understand that if I have provided any false or misleading information, or if material information is missing from this application or missing from any information provided by me to H2R Holdings Ltd, that I will not be accepted for employment by clients of H2R Holdings Ltd or if I am already employed by a client of H2R Holdings Ltd my employment can be terminated forthwith. In accordance with COVID-19 guidelines set down by the Ministry of Health, your contact details may need to be provided to the Ministry of Health and/or District Health Board for Contact Tracing purposes. You may access this information and request a correction by contacting us.

* I have read and agree to the above declaration