Trainee Application Form Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Age * 18-21 22-25 26-28 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Gender * Male Female Other Ethnicity * Residency Status * NZ Citizen NZ Permanent Resident Other (please give further details) If OTHER, please give further details Do you identify as having an intellectual disability or learning difference? * Yes No If YES, please give further details * Emergency Contact Name * First Name Last Name Email * Phone * (###) ### #### Relationship to Applicant * Have you left school? * Yes No If YES, what year did you leave? * If NO, when will you be leaving? * What secondary school did you attend/are attending? * List any unpaid work experience you have had * Are you currently in paid employment? If YES, please give further details * Do you need support with literacy and/or numeracy? If YES, please give further details * Thank you!
