Epro ID: ________________

CANDIDATE INFORMATION & CONSENT FORM (NZ ONLY)

Full Name            
(Surname) (First name)
Phone (h)       (w)       (m)      

Address      

Information provided on this form will be used in accordance with Hudson’s Privacy Policy. A copy of Hudson’s Privacy
Policy is available at each Hudson office or on our website at www.hudson.com

REFEREES

Tick to provide permission for Hudson to contact this referee without contacting you prior.

Please ensure you have contacted these referees to advise them that a reference check may be conducted by Hudson or
a Hudson client.

Referee 1 Referee 2 Referee 3

Name
                 
Title
                 
Organisation
                 
Phone (w)
                 
Phone (m)
                 
E-mail/fax
                 

Relationship to yourself
                 

From (mm/yy)       From (mm/yy)       From (mm/yy)      

Period of Employment
To (mm/yy)       To (mm/yy)       To (mm/yy)      

BACKGROUND & OTHER CHECKS

Hudson may require you to undergo the following background and other checks relevant to assisting you with finding or
retaining work with Hudson clients (“Purpose”). In completing this form, you consent to Hudson collecting your personal
information from the following third parties (“Third Parties”), and where required, disclosing your personal information to
the Third Parties to conduct the following checks.

Tick to provide permission for Hudson to conduct the following checks:

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Issue date: 15 February 2017

www.hudson.com
 Criminal conviction check conducted through the Ministry of Justice (or other relevant organisation)
Police infringement check conducted through the New Zealand Police Infringement Bureau (or other relevant
organisation)
Employment verification check conducted by Hudson (or a Hudson client) with any of your previous employers
to verify your employment history, including verification of dates of employment and position(s) held
Credit check conducted through Veda Advantage (or other relevant organisation)
Medical and/or drug and alcohol check conducted by an external testing provider

You authorise and consent to Hudson disclosing the personal information collected about you from Third Parties to
Hudson clients to be used for the Purpose described above.

ADDITIONAL INFORMATION

(1) Do you have any medical condition, disability or injury that may affect your ability to carry out any specific work duties,
or which may be aggravated or further contributed to by the performance of certain work duties?

No Yes
If you have answered yes, please provide details below. Please note any special adjustments or facilities that can be
provided to enable you to carry out the work duties.

     
     

(2) Have you been charged with a criminal offence (including driving offences), have any charges Yes No
pending, or had any other criminal convictions in New Zealand or overseas?

Note: you are not required to disclose any conviction which is concealed under the Criminal
Records (Clean Slate) Act 2004 (NZ).

(3) Have you been subject to an investigation for dishonesty or violence by a previous employer? Yes No

(4) Have you been dismissed from any previous employment? Yes No

If you have answered yes to any of the above questions, please provide further details below.

     
     

Candidate Signature: Date:      

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Issue date: 15 February 2017

www.hudson.com