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Application for Employment
Thank you for your interest in a role at the Department of Corrections.

The information you provide will be used in the selection process only. In the event that an appointment
review is conducted, a summary of the information may be provided to another applicant. If this is
required, you will be advised.

1. Position Information

    Job Title and Location:

    Vacancy Number:

2. Personal Information

    Surname/Family Name:

    First Names:

    Preferred Name (if different):

    Other names you have
    been known by:

    Postal Address:

    Daytime Telephone Number:

    Mobile Telephone Number:

3. Employment at the Department of Corrections
    If you are a current employee, do you give permission for your
                                                                               Yes     No 
    personal file to be seen during the appointment process?

    If you are not a current employee, have you ever been employed at
                                                                               Yes     No 
    the Department? Please provide further details below:
     Dates Employed       Position Title                                       Service/ Group & Region




4. Working in New Zealand
    Are you a NZ citizen?                        Yes     No 

    If No, do you have:     Residency Status?    Yes     No             Please attach copies of your
                                 Work Permit?    Yes     No             documents of eligibility.




                                                                                                         1
5. Health
   Do you have, or have you ever had, a medical or health condition,
   injury or illness or any other condition that may aggravate, contribute                       Yes        No 
   to or affect your ability to carry out the requirements of the job?
   If yes, please provide details of the condition and how this is likely to affect your work performance.




6. Criminal Conviction Details
   Have you ever been convicted of any offence against the law?                                  Yes        No 
   Note: Minor traffic offences such as parking infringements do not need to be declared,
   however drink driving offences should be declared.

   If Yes, please provide further details below:
    Date                                    Offence                                Sentence




   Important note : The Criminal Records (Clean Slate) Act 2004 determines the information you need to provide for
   this question.

   Applicants for jobs as prison officers, probations officers and related positions
   You must declare all your criminal convictions if you are applying for the following roles: corrections officer, senior
   corrections officer, principal corrections officer, unit manager, site manager, probation officer, senior probation officer,
   service manager, senior community work supervisor or community work supervisor.

   Applicants for other jobs
   If you meet the eligibility criteria under the Criminal Records (Clean Slate) Act 2004 you may answer the above question by
   stating that you have no criminal record. If you do not meet the eligibility criteria you are required to disclose your criminal
   conviction details. Please review the attached information to assist you to determine how this question should be
   answered.

   Do you have any criminal charges pending or under investigation?                              Yes        No 
   If Yes, please provide further details below:



   You will also be asked to complete a criminal conviction check that will be processed by the Ministry
   of Justice as part of the recruitment process.

7. Declaration
   I have truthfully completed all sections of this application form and have
   provided information that is accurate and complete to the best of my
   knowledge.                                                                                            Yes        No 
   I understand that providing misleading information or omitting any
   information that may be relevant to my suitability for the job may mean I
   can be disqualified from appointment, or if appointed, my employment
   may be terminated.                                                                                    Yes        No 

   Signature:                                                                                            Date:



   I understand that if I submit this form in an electronic copy it will
   constitute an electronic signature.                                                                   Yes        No 




                                                                                                                                 2
Information for Applicants

                                Criminal Conviction Checking

Why do I need to declare my criminal convictions?
Due to the nature of the Department’s work, it is our Policy to check a person’s criminal record before
any appointment is confirmed. Any offer of employment is made subject to obtaining a satisfactory
criminal clearance check. You are required to declare your criminal convictions on the application form
and criminal checks will also be conducted through the Ministry of Justice as part of the recruitment
process.

Our Policy on Criminal Convictions
Our Policy provides that a criminal conviction does not necessarily debar an applicant from
appointment. However, applicants with the following kinds of criminal record will not usually be
considered for appointment:
• Any person who has received a custodial sentence (includes periodic detention and corrective
   training) regardless of when the offence occurred
• Any conviction for violence, dishonesty, drugs, a sexual offence, or any offence which incurred a
   sentence of supervision within the last 20 years (Public Prison Service custodial positions) or 10
   years (other Public Prison Service positions, and all other services and groups)
• Any criminal conviction within the last 10 years, with the exception of minor convictions (Minor
   convictions are those incurring small fines)
• A continued history of minor offences

A General Manager of a Service or Group has discretion to appoint a person who has a criminal
record, where the General Manager decides that the potential benefits to the Department outweigh the
disadvantage of the criminal record.

As you can see from the Policy, having a criminal conviction will not necessarily preclude you from
being offered employment. It depends on the nature of the position you are applying for and the
nature of the offences that might be on your criminal records. Your criminal conviction record will be
reviewed against our policy to assess your suitability for employment with the Department.




                                                                                                        3
The Criminal Records (Clean Slate) Act 2004

                                          Information Sheet

1. What does the Criminal Records (Clean Slate) Act 2004 mean?
This legislation allows individuals with less serious convictions who have been conviction free for at
least seven years to put their past behind them. It will enable eligible individuals to conceal
convictions in certain circumstances, such as applying for a job unless an exception applies. Eligible
individuals can legitimately state that they have no criminal record for the purpose of applying for a job
at the Department.

There are exceptions for people applying to work in the Department in certain roles. In these cases
you are required to disclose your complete criminal record. Please see section 3 for information on the
exceptions.

2. What criteria do I have to meet to be eligible?
You must meet all of the criteria in section 7 of the Act before convictions can be concealed. The
information below is a summary and the Act should be consulted for full information. Information can
also be viewed at the Ministry of Justice website at www.justice.govt.nz .

You must have
   • No convictions within the last 7 years;
   • Never been sentenced to a custodial sentence as defined by the Act. This includes
      imprisonment, corrective training, preventive detention, imprisonment served by way of home
      detention, borstal training, detention centre training and full-time detention of an individual;
   • Never been ordered by a Court following a criminal case to be detained in a hospital due to
      your mental condition, instead of being sentenced;
   • Not been convicted of a “specified offence” e.g. sexual offending against children and young
      people or the mentally impaired);
   • Paid in full any fine, reparation or costs ordered by the Court in a criminal case;
   • Never been indefinitely disqualified from driving under section 65 Land Transport Act 1998 or
      earlier equivalent provision.

The Criminal Records (Clean Slate) Act is an automatic scheme, therefore it is not necessary to apply
for a clean slate.

3. Are there any circumstances where I am required to disclose my convictions or my
   convictions will still be disclosed?

Yes. There are exceptions under that Act where an individual’s convictions can continue to be
disclosed. If you apply for any of the roles listed below, you need to declare all your criminal
convictions in the Department’s application form and all your criminal convictions will be disclosed
during the criminal checking process.

Exceptions to the Clean Slate
• any person employed in a prison involved in custodial duties
• corrections officer
• senior corrections officer
• principal corrections officer
• unit manager
• site manager
• probation officer
• senior probation officer
• service manager
• senior community work supervisor


                                                                                                         4
•   community work supervisor
•   The term prison officer is defined in section 2 (1) of the Penal Institutions Act 1954 and the term
    Probation Officer is defined in section 4(1) of the Sentencing Act 2002.

4. What do I need to declare in the “Criminal Convictions Details” Question of the Application
For Employment Form?

a)     Positions covered by an exception
If you are applying for a position that is listed in the section above then you need to declare all your
criminal convictions on the application form. All your criminal convictions will also be disclosed during
the Ministry of Justice criminal checking process.

b)     All other positions
You need to determine whether you are an eligible individual under the Criminal Records (Clean Slate)
2004 Act.

Eligible Individuals
If you are an eligible individual (that is you meet the legislative requirements) you can state that you
do not have a criminal record for the purpose of your job application and you are not required to
declare your convictions on the application form. This does not mean that you were never convicted of
any offences, it just means for the purpose of applying for these types of jobs you are regarded, and
can state that you are conviction free.

If you are an eligible individual, your criminal convictions check through the Ministry of Justice will
automatically be clean slated.

Ineligible Individuals
If you are an ineligible individual (for example, you have had a custodial sentence, been convicted of
a specified offence, had a conviction in the last 7 years) your record cannot be wiped clean, as you are
not eligible under the Act. Under these circumstances you need to declare all your criminal convictions
on the Application Form. The Ministry of Justice criminal check will also list all your past convictions.

5. Where can I get further information about the Clean Slate Act?
Further information about the Clean Slate Act can be found at the Ministry of Justice website at
www.justice.govt.nz.




                                                                                                            5
•   community work supervisor
•   The term prison officer is defined in section 2 (1) of the Penal Institutions Act 1954 and the term
    Probation Officer is defined in section 4(1) of the Sentencing Act 2002.

4. What do I need to declare in the “Criminal Convictions Details” Question of the Application
For Employment Form?

a)     Positions covered by an exception
If you are applying for a position that is listed in the section above then you need to declare all your
criminal convictions on the application form. All your criminal convictions will also be disclosed during
the Ministry of Justice criminal checking process.

b)     All other positions
You need to determine whether you are an eligible individual under the Criminal Records (Clean Slate)
2004 Act.

Eligible Individuals
If you are an eligible individual (that is you meet the legislative requirements) you can state that you
do not have a criminal record for the purpose of your job application and you are not required to
declare your convictions on the application form. This does not mean that you were never convicted of
any offences, it just means for the purpose of applying for these types of jobs you are regarded, and
can state that you are conviction free.

If you are an eligible individual, your criminal convictions check through the Ministry of Justice will
automatically be clean slated.

Ineligible Individuals
If you are an ineligible individual (for example, you have had a custodial sentence, been convicted of
a specified offence, had a conviction in the last 7 years) your record cannot be wiped clean, as you are
not eligible under the Act. Under these circumstances you need to declare all your criminal convictions
on the Application Form. The Ministry of Justice criminal check will also list all your past convictions.

5. Where can I get further information about the Clean Slate Act?
Further information about the Clean Slate Act can be found at the Ministry of Justice website at
www.justice.govt.nz.




                                                                                                            5

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Applicationfor employment[2]

  • 1. Application for Employment Thank you for your interest in a role at the Department of Corrections. The information you provide will be used in the selection process only. In the event that an appointment review is conducted, a summary of the information may be provided to another applicant. If this is required, you will be advised. 1. Position Information Job Title and Location: Vacancy Number: 2. Personal Information Surname/Family Name: First Names: Preferred Name (if different): Other names you have been known by: Postal Address: Daytime Telephone Number: Mobile Telephone Number: 3. Employment at the Department of Corrections If you are a current employee, do you give permission for your Yes  No  personal file to be seen during the appointment process? If you are not a current employee, have you ever been employed at Yes  No  the Department? Please provide further details below: Dates Employed Position Title Service/ Group & Region 4. Working in New Zealand Are you a NZ citizen? Yes  No  If No, do you have: Residency Status? Yes  No  Please attach copies of your Work Permit? Yes  No  documents of eligibility. 1
  • 2. 5. Health Do you have, or have you ever had, a medical or health condition, injury or illness or any other condition that may aggravate, contribute Yes  No  to or affect your ability to carry out the requirements of the job? If yes, please provide details of the condition and how this is likely to affect your work performance. 6. Criminal Conviction Details Have you ever been convicted of any offence against the law? Yes  No  Note: Minor traffic offences such as parking infringements do not need to be declared, however drink driving offences should be declared. If Yes, please provide further details below: Date Offence Sentence Important note : The Criminal Records (Clean Slate) Act 2004 determines the information you need to provide for this question. Applicants for jobs as prison officers, probations officers and related positions You must declare all your criminal convictions if you are applying for the following roles: corrections officer, senior corrections officer, principal corrections officer, unit manager, site manager, probation officer, senior probation officer, service manager, senior community work supervisor or community work supervisor. Applicants for other jobs If you meet the eligibility criteria under the Criminal Records (Clean Slate) Act 2004 you may answer the above question by stating that you have no criminal record. If you do not meet the eligibility criteria you are required to disclose your criminal conviction details. Please review the attached information to assist you to determine how this question should be answered. Do you have any criminal charges pending or under investigation? Yes  No  If Yes, please provide further details below: You will also be asked to complete a criminal conviction check that will be processed by the Ministry of Justice as part of the recruitment process. 7. Declaration I have truthfully completed all sections of this application form and have provided information that is accurate and complete to the best of my knowledge. Yes  No  I understand that providing misleading information or omitting any information that may be relevant to my suitability for the job may mean I can be disqualified from appointment, or if appointed, my employment may be terminated. Yes  No  Signature: Date: I understand that if I submit this form in an electronic copy it will constitute an electronic signature. Yes  No  2
  • 3. Information for Applicants Criminal Conviction Checking Why do I need to declare my criminal convictions? Due to the nature of the Department’s work, it is our Policy to check a person’s criminal record before any appointment is confirmed. Any offer of employment is made subject to obtaining a satisfactory criminal clearance check. You are required to declare your criminal convictions on the application form and criminal checks will also be conducted through the Ministry of Justice as part of the recruitment process. Our Policy on Criminal Convictions Our Policy provides that a criminal conviction does not necessarily debar an applicant from appointment. However, applicants with the following kinds of criminal record will not usually be considered for appointment: • Any person who has received a custodial sentence (includes periodic detention and corrective training) regardless of when the offence occurred • Any conviction for violence, dishonesty, drugs, a sexual offence, or any offence which incurred a sentence of supervision within the last 20 years (Public Prison Service custodial positions) or 10 years (other Public Prison Service positions, and all other services and groups) • Any criminal conviction within the last 10 years, with the exception of minor convictions (Minor convictions are those incurring small fines) • A continued history of minor offences A General Manager of a Service or Group has discretion to appoint a person who has a criminal record, where the General Manager decides that the potential benefits to the Department outweigh the disadvantage of the criminal record. As you can see from the Policy, having a criminal conviction will not necessarily preclude you from being offered employment. It depends on the nature of the position you are applying for and the nature of the offences that might be on your criminal records. Your criminal conviction record will be reviewed against our policy to assess your suitability for employment with the Department. 3
  • 4. The Criminal Records (Clean Slate) Act 2004 Information Sheet 1. What does the Criminal Records (Clean Slate) Act 2004 mean? This legislation allows individuals with less serious convictions who have been conviction free for at least seven years to put their past behind them. It will enable eligible individuals to conceal convictions in certain circumstances, such as applying for a job unless an exception applies. Eligible individuals can legitimately state that they have no criminal record for the purpose of applying for a job at the Department. There are exceptions for people applying to work in the Department in certain roles. In these cases you are required to disclose your complete criminal record. Please see section 3 for information on the exceptions. 2. What criteria do I have to meet to be eligible? You must meet all of the criteria in section 7 of the Act before convictions can be concealed. The information below is a summary and the Act should be consulted for full information. Information can also be viewed at the Ministry of Justice website at www.justice.govt.nz . You must have • No convictions within the last 7 years; • Never been sentenced to a custodial sentence as defined by the Act. This includes imprisonment, corrective training, preventive detention, imprisonment served by way of home detention, borstal training, detention centre training and full-time detention of an individual; • Never been ordered by a Court following a criminal case to be detained in a hospital due to your mental condition, instead of being sentenced; • Not been convicted of a “specified offence” e.g. sexual offending against children and young people or the mentally impaired); • Paid in full any fine, reparation or costs ordered by the Court in a criminal case; • Never been indefinitely disqualified from driving under section 65 Land Transport Act 1998 or earlier equivalent provision. The Criminal Records (Clean Slate) Act is an automatic scheme, therefore it is not necessary to apply for a clean slate. 3. Are there any circumstances where I am required to disclose my convictions or my convictions will still be disclosed? Yes. There are exceptions under that Act where an individual’s convictions can continue to be disclosed. If you apply for any of the roles listed below, you need to declare all your criminal convictions in the Department’s application form and all your criminal convictions will be disclosed during the criminal checking process. Exceptions to the Clean Slate • any person employed in a prison involved in custodial duties • corrections officer • senior corrections officer • principal corrections officer • unit manager • site manager • probation officer • senior probation officer • service manager • senior community work supervisor 4
  • 5. community work supervisor • The term prison officer is defined in section 2 (1) of the Penal Institutions Act 1954 and the term Probation Officer is defined in section 4(1) of the Sentencing Act 2002. 4. What do I need to declare in the “Criminal Convictions Details” Question of the Application For Employment Form? a) Positions covered by an exception If you are applying for a position that is listed in the section above then you need to declare all your criminal convictions on the application form. All your criminal convictions will also be disclosed during the Ministry of Justice criminal checking process. b) All other positions You need to determine whether you are an eligible individual under the Criminal Records (Clean Slate) 2004 Act. Eligible Individuals If you are an eligible individual (that is you meet the legislative requirements) you can state that you do not have a criminal record for the purpose of your job application and you are not required to declare your convictions on the application form. This does not mean that you were never convicted of any offences, it just means for the purpose of applying for these types of jobs you are regarded, and can state that you are conviction free. If you are an eligible individual, your criminal convictions check through the Ministry of Justice will automatically be clean slated. Ineligible Individuals If you are an ineligible individual (for example, you have had a custodial sentence, been convicted of a specified offence, had a conviction in the last 7 years) your record cannot be wiped clean, as you are not eligible under the Act. Under these circumstances you need to declare all your criminal convictions on the Application Form. The Ministry of Justice criminal check will also list all your past convictions. 5. Where can I get further information about the Clean Slate Act? Further information about the Clean Slate Act can be found at the Ministry of Justice website at www.justice.govt.nz. 5
  • 6. community work supervisor • The term prison officer is defined in section 2 (1) of the Penal Institutions Act 1954 and the term Probation Officer is defined in section 4(1) of the Sentencing Act 2002. 4. What do I need to declare in the “Criminal Convictions Details” Question of the Application For Employment Form? a) Positions covered by an exception If you are applying for a position that is listed in the section above then you need to declare all your criminal convictions on the application form. All your criminal convictions will also be disclosed during the Ministry of Justice criminal checking process. b) All other positions You need to determine whether you are an eligible individual under the Criminal Records (Clean Slate) 2004 Act. Eligible Individuals If you are an eligible individual (that is you meet the legislative requirements) you can state that you do not have a criminal record for the purpose of your job application and you are not required to declare your convictions on the application form. This does not mean that you were never convicted of any offences, it just means for the purpose of applying for these types of jobs you are regarded, and can state that you are conviction free. If you are an eligible individual, your criminal convictions check through the Ministry of Justice will automatically be clean slated. Ineligible Individuals If you are an ineligible individual (for example, you have had a custodial sentence, been convicted of a specified offence, had a conviction in the last 7 years) your record cannot be wiped clean, as you are not eligible under the Act. Under these circumstances you need to declare all your criminal convictions on the Application Form. The Ministry of Justice criminal check will also list all your past convictions. 5. Where can I get further information about the Clean Slate Act? Further information about the Clean Slate Act can be found at the Ministry of Justice website at www.justice.govt.nz. 5