Intermediate/Senior Corporate & Commercial Solicitors

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Are you legally entitled to work in New Zealand?

Are you a NZ citizen?Yes
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Criminal Convictions: As the position and the firm require a high level of trust and confidence, have you ever been convicted of any criminal offence that involves fraud, dishonesty or acts of assault or violence, or are there any criminal charges pending? You need to be aware that under the Criminal Records (Clean Slate) Act 2004, you may not be required to disclose certain convictions that are covered by the Act.Yes
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Employment Record: Have you ever had your employment terminated for reasons of poor performance or misconduct?Yes
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Employment Record: Have you ever been on a performance improvement or performance management plan?Yes
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Health: (all information will be kept confidential. Answers to all questions are compulsory) Do you currently have or at any time had any gradual process disease, infection or symptoms of occupational overuse syndrome ("OOS") that may affect your ability to carry out the requirements of the position?Yes
No

Health: Are you aware of any current or past medical or health related condition (including any stress related illness) or any injuries that may affect your ability to carry out the full range of requirements required of this position, or which may be aggravated/further contributed by any tasks of this job or may require us to take particular steps to safeguard your health at work?Yes
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If you have answered yes to the question above, please explain:

Health: Are there any special services or facilities which we could provide you to assist you in carrying out your work duties?Yes
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If yes, please list what these are:

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Do you hold a current NZ practising certificate?Yes
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If no, when did your NZ practising certificate expire?

If you do not hold a NZ practising certificate, under which jurisdiction have you held one?

What is your date of admission?

As a lawyer, have you been the subject of any NZ or overseas Law Society complaints, or do you have any pending?Yes
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As a lawyer, have you been the subject of any NZ or overseas litigation or do you have litigation pending?Yes
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Personal Declaration and Signature: I declare that the information provided in this form and other documents and correspondence provided in the process of my application are true and correct and provide a balanced and complete view of the details relevant to considering me for employment. I understand that any incorrect, misleading or omitted information may disqualify me from appointment, or if already appointed, that my employment may be terminated. I also understand that any false information given in relation to the health section of this form may result in my loss of entitlement to any work-related compensation as well as possible dismissal from employment. I acknowledge that the written comments and assessments on my suitability, interview notes, referee comments and psychological assessment comments will be deemed evaluative and therefore confidential to Simpson Grierson. I acknowledge and consent to all application-related documents, including the evaluative information described above, being stored in Simpson Grierson's cloud-based recruitment database for a period of five years for the purpose of considering me for current and future roles at Simpson Grierson. I consent to Simpson Grierson seeking verbal or written information about me on a confidential basis from the referees I have nominated or to obtain information about me from the New Zealand Law Society or the relevant overseas law society to confirm my professional record as provided and I authorise the information requested to be released. I have read and accepted the above statement.Yes
No

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