Corstorphine Baptist Community Trust

Application Form – CBCT Support Worker

Personal Information

Legal entitlement to work in New Zealand:
Do you have a full New Zealand driver's licence?
Do you have access to a registered and warranted vehicle to use in your day to day work?
Do you have a current First Aid Certificate?
If yes, please provide:
Do you have Careerforce Qualifications?
Do you have a relevant higher tertiary qualification?

Employment History

Please list your 2 most recent employers below:
Have you previously worked for CBCT?
Do you have any secondary employment?


Please provide a minimum of two people who you have reported to as your supervisor/manager, who can be contacted by us to provide a reference. If you are currently employed, one referee MUST be your current employer. Please note: Referees may be contacted prior to your interview.
If you have not been employed before or are returning to work after several years please provide contact details of people from whom a confidential (personal) reference can be obtained (this person is to be a non-family member whom you have known for a minimum of two years).


Are you suffering from, or have you ever suffered from, any injuries or medical conditions caused by gradual process, disease or infection (e.g. hearing loss, occupational overuse syndrome, back injury) which may be aggravated by the duties required for this position?
Do you have other physical or mental challenges/concerns not stated above that may affect your ability to work?
Are you on any medication(s) that may affect your ability to perform the duties required of this position?
Note: Any false or misleading information given in relation to your medical history regarding gradual process, disease or infection may result in the loss of entitlement for any compensation from ACC and may lead to the termination of your employment.

Availability to Work

What type of work are you looking for?
In some residential services, CBCT provides 24 hours rostered support.
Are you prepared to work a variety of shifts?
Have you worked shifts before?
What is your Covid-19 vaccination status?

Criminal & Traffic Offences

Have you ever been convicted of any offences against the law in New Zealand or in any other country (other than minor traffic offences)?
Are you awaiting the hearing of a charge in a Civil or Criminal Court of Law?
It is a requirement of CBCT that all applicants undergo a Police Vetting Check. For those applying to work in a Child and Youth Service a CYRAS Check through Oranga Tamariki will also be required.
I declare that to the best of my knowledge the answers given in this application are complete and correct. I have read, understood and agree to the provisions of this Application Form. If I am employed before the results of my Police Vetting Check are supplied to CBCT, I understand that my employment may be terminated if the Police Vetting Check reveals information that CBCT considers makes me unsuitable for the job or which contradicts statements I have made in my application. I understand that if I have supplied any incorrect, false or misleading information, or if I have suppressed any material information, I may not be offered the position applied for or, if employed, my employment may be terminated.