Application for Employment

Supplementary information

In order to apply for employment with the Electricity Authority we request that you complete this form in addition to providing a cover letter and a CV.

Privacy of information

Information arising from and contained in this form is strictly confidential, and will be stored by the Electricity Authority's HR team and used solely for the purpose of determining an appointment decision for the position of:

The provision of information in this form is voluntary but is required by the Electricity Authority in order to consider your application for employment. If you do not complete all parts of this form, it may affect the Authority's ability to consider your application. You have the right to access and correct any personal information that is held by the Electricity Authority, including on this form.

1. Identity

2. New Zealand Employment Status

If you require a visa to work in New Zealand, please attach a photocopy of the appropriate authorisation.

Max 2MB size. Allowed doc, docx, jpeg, jpg, pdf, png, txt file types.
Are you legally entitled to work and live in New Zealand without restriction?
If you are not legally entitled to work in New Zealand, have you commenced visa application process?

3. Convictions and proceedings

Except as protected by the Criminal Records (Clean Slates) Act 2004, have you ever been convicted of any criminal offence, whether in New Zealand or overseas?

Information about the Clean Slate protections is available on the Ministry of Justice website: Clean Slate Protections

Are you awaiting the hearing of any proceedings or criminal charges in a Court or Regulatory Authority, whether in New Zealand or overseas?
Are you aware of any circumstances that might lead you to being charged with a criminal offence, or of any current Police or regulatory body investigation regarding you, whether in New Zealand or overseas?
Have you ever been disciplined or dismissed from previous employment for dishonesty, fraud, theft, assault, or alcohol or substance abuse?

If offered employment with the Authority, you will be required to complete a request to the Ministry of Justice to provide the Electricity Authority with a copy of information on you, held in their computer systems.

4. Business and Professional Record

Have you been a Director or Manager of a company, incorporate society, credit union, charitable body, friendly society or other entity, which has been placed into liquidation or receivership?
Have you or any company which you have managed or directed been found guilty of any breach(es) of the Companies Act or other Business Law or regulations, or legislation governing Incorporated Societies?
Have you ever been found in breach of the rules or Code of Conduct of any professional body or industry organisation of which you are or have been a member?
Have you ever entered into bankruptcy or any material accommodation with creditors?

5. Conflicts of interest

Do you know of any conflicts of interest with people and/or the work of the Authority?

6. Availability

7. Salary expectations

8. Health and Safety

This information is required to enable us to maintain a safe and healthy work environment for staff, consistent with obligations under the Health and Safety at Work Act 2015 and Accident Insurance Act 2000. Appointees must be able to perform job responsibilities in a way that will not cause harm to themselves or others.

Do you have any injury, illness, disability, health or medical condition which may affect your ability to perform the duties of the role you have applied for, or which may be impacted by activities to which you could reasonably expect to undertake in the workplace, or which may potentially cause harm to other employees?

Are you taking any medication which may effect your performance in or ability to perform the duties of the role you have applied for?

9. Referees

Please provide the details of two referees that you are happy for us to contact. Ideally your referees should be someone you reported directly to in a former role.

Referees will not be contacted without firstly seeking your permission.


I declare that the information I have provided in this form and in the accompanying cover letter and CV is correct and complete, and I understand that any incorrect, misleading or omitted information may disqualify me from appointment, or if I am appointed, may result in being dismissed.

I further declare that I am not aware of any personal or medical condition or circumstance that would limit my ability to successfully perform the duties of the role to which I seek appointment.

Please attach a cover letter and a copy of your CV

Max 2MB size. Allowed doc, docx, jpeg, jpg, pdf, png, txt file types.
Max 2MB size. Allowed doc, docx, jpeg, jpg, pdf, png, txt file types.

Online job application information collected: We collect personal information contained in job applications that are submitted via this website. We treat your personal information as confidential and we will only use it for the purpose of making a decision about the position for which you are applying. Your personal information is deleted after three months. Except as authorised by the Privacy Act 1993, we will not disclose your personal information to any third party. You have the right to request access to any personal information that we hold about you. For further information on your rights under the Privacy Act 1993, see