Corporate/Commercial Senior Solicitor/Senior Associate

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Are you legally entitled to work in New Zealand?

Are you a NZ citizen?Yes
No

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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
No

Employment Record: Have you ever had your employment terminated for reasons of poor performance or misconduct?Yes
No

Employment Record: Have you ever been on a performance improvement or performance management plan?Yes
No

Health: (all information will be kept confidential. Answers to all questions are compulsory) Do you currently have or at any time have 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 health condition or injury (whether physical or psychological) that: (a) may affect your ability to carry out the full range of requirements of this position safely and effectively; and/orYes
No

Health: (b) which may be aggravated/further contributed to by any tasks of this job; and/or

Health: (c) which may require us to take particular steps to safeguard your health at work; and/or

Health: (d) which may require you to take sick leave of more than five days over a consecutive period, or more than 10 days per annum?

If you have answered yes to any of the health questions above, please explain:

Health: Do you require any workplace adjustments, accommodations, services or facilities to enable you to perform this role?Yes
No

If yes, please specify:

Health: In connection with the health condition or injury notified above, in the last twelve months, have you had to take a consecutive period of five days or more of sick leave for injury or illness, or more than ten days of sick leave for injury or illness on a non-consecutive basis?

Health: If yes, please provide any further relevant details:

University attended:

Primary degrees/years:

Do you hold a current NZ practising certificate?Yes
No

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
No

As a lawyer, have you been the subject of any NZ or overseas litigation or do you have litigation pending?Yes
No

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 or misleading information given or deliberate failure to disclose information in relation to the health section of this form may result in loss of entitlement to any work-related compensation, disciplinary action 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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