EMPLOYRITE

 LTD  NEW  ZEALAND  

P. 0064  9 910 0553
E. nzoffice@employrite.com
PO  Box  523,  Pukekohe
New Zealand 2120  

Personal Details
New  Zealand
Title: Mr/Mrs/Miss/Ms: Date of Birth:
Mr. September 19, 1993
Surname: Nationality:
Mendoza Filipino
Forename(s): Town of Birth:
Jhameil Ryan Naguilian La Union
Surname at Birth: Passport Number:
Mendoza P0778341B
Date of Surname change: Passport Issue Date:
February 21, 2019
Mother’s Maiden Name: National Insurance Number:
Conchita G. Picazo
Address History
In order for us to process your details we need you to provide a continuous 5 year address history
including all periods of residency abroad.

Unit 514, The Rochester, Elizco Road, San Joaquin, Pasig City, 1601
Current Address: _______________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Dates Resided from: December 2019 Dates Resided to: Present
#155 Middle Rock Quarry, Baguio City, 2600
Address 2:_____________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Dates Resided from: January 1998 Dates Resided to: Present

Address 3: _____________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Dates Resided from: Dates Resided to:

Address 4: _____________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Dates Resided from: Dates Resided to:

+63279140836
Home Telephone: ________________________ +639390860535
Mobile: ____________________________________
Work Telephone: _________________________ jrmendzz@gmail.com
Email: _____________________________________

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 EMPLOYRITE  LTD  NEW  ZEALAND  
P. 0064  9 910 0553
E. nzoffice@employrite.com
PO  Box  523, Pukekohe
New Zealand 2120  

Declaration OfNew  
ConsentZealand  

I declare that the information I have given on this form is true and complete to the best of my knowledge and belief. In addition,
I understand that any false information or deliberate omission in the information given on this form may disqualify me from
employment with Client.

Signature:______________________________________________________________________________________

Jhameil Ryan Mendoza

Print Name:____________________________________________________________________________________

August 9, 2021
Date:__________________________________________________________________________________________

I hereby authorise Credence Background Screening Ltd, an independent agency acting on behalf of the Client or any agent
thereof, to verify all the information I have presented on my pre-employment screening application form.

I undertake to co-operate fully with Employrite Limited and their agent, Credence to provide any further information that is
necessary to complete the required screening process.

I understand that the “personal” data (as defined by the Data Protection Act 1998) I have supplied and the subsequent personal
data that is obtained on me by Employrite Limited, their agent, Credence and the Client will only be used exclusively for the
purpose that is intended for and will be stored by Employrite Limited and their agent, Credence for a period no longer than it is
required.

I authorise Employrite Limited and their agent, Credence or any agent thereof to contact my school, college or university to
obtain information regarding my educational qualifications gained. I also give permission to Employrite Limited and their agent,
Credence and any agent thereof to perform employment reference checks to cover my work history and to contact the
Department for Work and Pensions to confirm periods of unemployment (if applicable).

I understand that as part of my employment Client may ask that a Basic Criminal Record check be conducted on me. I hereby give
consent for Employrite Limited and their agent, Credence to apply for, receive and view my Disclosure certificate. I also give my
permission for the Disclosure certificate to be presented by Credence Background Screening Ltd to Client for the sole purpose of
the required screening process.

I authorise Employrite Limited and their agent, Credence to carry out all other necessary background checks relating to my
employment which I have been made aware of by Client.

I confirm that my consent is explicit, fully informed and freely given for my personal data to be processed for the sole purpose of
employment with Client.

Signature:______________________________________________________________________________________

Jhameil Ryan Mendoza

Print Name:____________________________________________________________________________________

August 9, 2021
Date:__________________________________________________________________________________________

Have you supplied your identification documents to support your application for a Basic Level Criminal record Check?

YES □ NO □
Employrite Limited and their agent, Credence Background Screening Ltd and Client will protect the information provided by you
and will ensure that it is not passed onto anyone who is unauthorised to see it. All information that you supply will be treated in
the strictest confidence.

Credence Background Screening Ltd, Tubs Hill House, London Road, Sevenoaks, Kent TN13 1BL
Tel: 01732 748900, Fax: 01732 748901, Email: info@credence.co.uk , Website: www.credence.co.uk  

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