Bed Bath And Beyond Careers Form – Fill Out and Use This PDF

EMPLOYMENT APPLICATION

ALL DETAILS PROVIDED WILL REMAIN STRICTLY CONFIDENTIAL. PLEASE PROVIDE A COPY OF YOUR CV WITH THIS APPLICATION FORM

REFEREES

PLEASE LIST THREE REFEREES THAT WE CAN CONTACT – TWO MUST NOT BE FRIENDS OR FAMILY

GENERAL INFORMATION

Are you prepared to work rosters (including Saturdays and or Sundays)?

Due to the nature of 7 day trading and rosters, is there any reason you foresee which it may affect your ability to fulfill your required duties

Within the position you are applying for?

If YES, please detail:

Do you have any cultural or religious beliefs or other commitments such as sports that may affect your ability to be available to fulfill rosters

required of you?

If YES please detail:

Are you aware of any injury or illness you have that may affect your work performance with us?

Are you in receipt of any benefit that would affect your availability?

If YES please detail:

Are you in receipt of any benefit relating to any such illness or injuries?

If YES please detail:

Are you taking any medication that could affect your work performance with us?

If YES please detail:

Do you have any medical condition that prevents you from heavy lifting, climbing ladders, working prolonged shifts?

If YES please detail:

Have you previously made any claims(s) to ACC for any injury, illness or any condition effecting your employment or have any claims pending:

Have you ever had any Police diversion for any criminal offence that could affect your employment or awaiting the outcome of any proceedings?

Has any employment tribunal found against you in any employment related issue or do you have any matters still pending?

Do you have any previous criminal convictions or any matters pending or before the courts?

Do you know anyone currently employed by this company?

If YES please give details:

Have you previously been employed by this company?

If YES please give details:

In relation to your previous work history have you included all previous employees and their full details?

If NO please give details why?

DECLARATION

1)I _______________________________ (PRINT FULL NAME) declare that to the best of my knowledge, the answers I have to the questions in this application form 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 it may be considered serious misconduct and my employment may be terminated forthwith.

2)I irrevocably authorize you and/or agent to contact all outside agencies any my previous and current employers, including any employers that I have not nominated on this application, information so gained, is supplied in confidence as evaluative material and will not be disclosed to me.

3)If the named referee is not authorized to speak on behalf of the Company, or not available, inquiries can be made with and other duly authorized person.

4)If required, inquiries may be made with the Accident Rehabilitation and Compensation Insurance Corporation (ACC)

5)As part of this application being actioned, a credit check may be done.

6)Bed Bath and Beyond may use Securitek (NZ) Limited or another employee screening company to review applicants and for recording reasons for terminations of employment.

7)If you are successful in obtaining employment with us or while we are considering your employment your application may be reviewed by Securitek (NZ) Limited or another employee screening agency. If you leave your employment, the reason left may be recorded by this agency.

8)By completing this application and declaration you agree to your application being reviewed. You are entitled to seek access to material held by any agency about you; however the Privacy Act allows some information to be refused in some circumstances. If you do not agree with the information held about you, you may ask that it be corrected.

9)I further irrevocably authorize you to furnish a third party, details of this application and any subsequent dealings that I may have with you as a result of this application being actioned by you.

10)I irrevocably authorize Securitek (NZ) Limited or any other employee screening agency to furnish to the company processing this application, the details of any Criminal History or Driver history and to obtain the same.

11)All details provided will remain strictly confidential and will be used only for the purpose of obtaining employment with Bed Bath and Beyond Limited. I understand that if I am offered employment or my application is being considered my application form may be released to Securitek (NZ) Limited or any other employee screening agency for the purpose of pre-employment screening. Unsuccessful applications remain on file for a period of approximately 6 months after which time they are destroyed. You reserve the right to request that your application be returned should you not obtain employment with Bed Bath and Beyond Limited.

I HAVE READ THIS APPLICATION AND DECLARATION AND HAVE HAD THE OPPORTUNITY TO SEEK INDEPENDENT ADVICE AS TO ITS CONTENTS AND FULLY UNDERSTAND IT.