M25-SECURITY
PRE-EMPLOYMENT INFORMATION
Name:
_____________________________________________
Electorate: _____________________________________________
Role:
_____________________________________________
We are excited to progress you through to our pre-employment checking process for a position in
our Electorate.
You will need to provide information so we can carry out reference checks and a Ministry of
Justice check, as part of our vetting process.
Please contact ____________________ on ____________________ if you have any questions.
References
Please complete the referee details below. By submitting, you consent to any referees being
contacted:
Referee 1
Referee name
Referee relationship
Referee contact number
Referee email address
Referee 2
Referee name
Referee relationship
Referee contact number
Referee email address
1
M25-SECURITY
Ministry of Justice Information
Please provide the following information for us to carry out your Criminal Record or Traffic
offence, Ministry of Justice check.
General Information
Full Name
Date of Birth *
Place of Birth *
Drivers License Number
Proof of Identification *
Please provide a copy of any of the following identification document:
- NZ Driver’s License – can be expired up to 2 years
- NZ passport – can be expired up to 2 years
- Current Overseas passport
- Current NZ firearms license
Previous Address(s) Information
Do you have any other New Zealand addresses you have lived at in the past 10 years?
☐ Yes, please enter previous address(s) in the space provided below
☐ No – proceed to next section
Previous Address 1
Street Address
Suburb
City
Postcode
Region
Country
2
M25-SECURITY
Previous Address 2
Street Address
Suburb
City
Postcode
Region
Country
Previous Address 3
Street Address
Suburb
City
Postcode
Region
Country
Previous Name Information
Have you been known by any other name(s)?
☐ Yes, please enter previous name(s) in the space provided below
☐ No
Previous Names
Last Name
First Name
Middle Name
1
2
3
3
