Whānau Mahi Application Form
Applicant will be required to come in for an interview and all application acceptances are subject to approval. 
Email *
APPLICATION DETAILS
First Name *
Surname *
Preferred Name *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Suburb
Town/City *
Mobile Number *
Home Number
MSD Number
MSD Branch
What is your gender? *
Do you have any existing medical or physical conditions or disabilities that may affect some forms of employment? *
If you answered Āe/yes, please use this space to list any conditions, injuries or disabilities that may affect some forms of employment i.e. back injury, epilepsy 
Drivers Licence *
Do you have a CV?
Clear selection
Do you have Photo ID? *
Do you have Reliable Transport?
Clear selection
Do you have Internet at Home
Clear selection
How many people live with you? *
How did you find out about Te Aitarakihi and our Whānau Mahi Programme? *
What are your ideal working conditions? "I want to work..."
Clear selection
WHAKAPAPA
Are you of Māori descent? *
Iwi
Hapū
Rohe
If not Māori, what is your ethnic group?
CONSENT
I give permission for Te Aitarakihi to hold this information. I understand that Te Aitarakihi may use the information provided for future planning and funding applications.  Outside of this, my information will not be forwarded  to any other service or organisation without my permission. *
A copy of your responses will be emailed to .
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