Fillable 208.20 Permitted Employee Application Pack (Accident Compensation Corporation New Zealand)

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208.20 Permitted Employee Application Pack (Accident Compensation Corporation New Zealand)

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Country of origin: NEW-ZEALAND
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208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Employer (Franchise name): _____________________________________ (Franchise number): ____________
Employee
Name:
First Middle Last
Address:
Phone Number/s:
Date of Birth:
Country of Origin:
Gender:
Yes
No
New Zealand Citizen – Section 1 (employee to complete and supply required documents)
Non New Zealand Citizen – Section 2 (employee to complete and supply required documents)
Yes
No
MoJ Request for Criminal Conviction History (employee to complete)
Proof of Identity attached (Step 3)
Yes
No
CrestClean ID Card and Privacy Declaration (employee to complete)
Passport Photo (attached as a .jpg)
Yes
No
The online Cleaning Health and Safety Induction provides employees with an understanding of Health and Safety responsibilities
and practices and must be successfully completed before clearance to work on any CrestClean site is given. Please clearly print the
employee’s email address to enable a link to the Team CrestClean induction to be sent to them.
Employee Email:
Permitted Employee Checklist
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Yes
No
Employment Declaration (employee and employer to complete)
Yes
No
IRD Employer Registration Letter
7. Uniform Required – To be vetted by the Regional Manager
Yes
No
The Regional Manager must inspect the uniform and deem it of good quality for the new employee
Size
1 x CrestClean Pants (Sizes: 2XS, XS, S, M, L, XL, 2XL, 3XL, 4XL)
$52.32
2 x CrestClean Polo shirt (Sizes: 3XS, 2XS, XS, S, M, L, XL, 2XL, 3XL, 4XL)
$83.96
8. Permitted Employee Fees Paid - $100.00 + GST (excludes uniform)
Yes
No
(Note this is non-refundable. If uniform (2 x polos and 1 x pants) is selected, the total cost is $251.28)
Paid by deduction (Deduction Authority Form D025 attached)
9. Regional Manager Declaration
I, ________________________________ , approve, ___________________________ as a CrestClean employee,
(Name of Regional Manager) (Name of Potential Employee)
subject to a Work Entitlement check, MoJ Criminal History check and completed online Health and Safety induction.
Signed: ______________________________________________ Date: ____________________________________
Regional Manager to email all forms including attachments to CrestClean Security, security@crestclean.co.nz
Permitted Employee Checklist
It is an offence under the Immigration Act 2009 to allow, or continue to allow, someone to work for you who is not
entitled to do so. Crest Commercial Cleaning Limited (CrestClean) requires evidence of entitlement to work from all
Franchisee prospects and employees whether they are New Zealand citizens or non-New Zealander’s. Options for
acceptable evidence are tabled below.
REGIONAL MANAGER - Please indicate below the original evidence sighted, sign & date below and send a photocopy of the
documents to Crest Admin with the completed Permitted Employee Application.
Full Name:
New Zealand Citizen
Option1:
New Zealand Passport
Original sighted
Colour photocopy attached
Option 2:
New Zealand birth certificate and photo identification
Original birth certificate sighted
Photocopy attached
Original photo ID sighted
Photocopy attached
Option 3:
New Zealand citizen certificate and photo identification
Original citizenship certificate sighted
Photocopy attached
Original photo ID sighted
Photocopy attached
Non-New Zealand Citizen
Option 4:
Foreign passport with a New Zealand residence class visa
Original foreign passport sighted
Colour photocopy attached
Original visa in passport sighted
Photocopy of visa attached
Option 5:
Foreign passport with a valid New Zealand visa with conditions that allow the person to work
Original foreign passport sighted
Colour photocopy attached
Original visa in passport sighted
Photocopy of visa attached
Option 6:
Australian passport
Original Australian passport sighted
Colour photocopy attached
Option 7:
Foreign passport with an Australian permanent residence visa or a current returning resident’s visa
Original foreign passport sighted
Colour photocopy attached
Original Australian residence
Photocopy of visa attached
visa in passport sighted
I, (Employee Name) give Crest permission to check my immigration status
for the purpose of employment eligibility only. This Agreement also permits any further check of my immigration
status should I need to supply a new visa in the future.
REGIONAL MANAGER for
THE EMPLOYEE
CREST COMMERCIAL CLEANING LTD
Signed
Signed
Name
Name
Date
Date
Work Entitlement Agreement - Employee
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
CrestClean ID Card
Cards will be issued only to prospective franchisees/employees who have passed the
CrestClean security vetting process (which includes a Ministry of Justice Criminal Conviction
History check) and online Cleaning Health and Safety Induction.
You must have a valid CrestClean ID Card before you are permitted on a CrestClean
customer site. CrestClean ID Cards are not transferrable and if an employee is wanting to
work for another franchise that franchisee must contact CrestClean. CrestClean ID Cards are
the property of CrestClean and must be returned to CrestClean when requested and at the
termination of your franchise/employment:
Crest Commercial Cleaning Limited, PO Box 740, Dunedin
Privacy Statement
The information that CrestClean collects is for the purpose of conducting a Ministry of Justice Criminal Background
Check, creating a photographic ID Card and to ensure that all workers are eligible to work in New Zealand.
CrestClean may share your personally identifiable information within the organisation or to CrestClean customers to
inform them of who is operating on their premises. CrestClean will not disclose any personally identifiable
information to an unknown third party unless we believe in good faith that we are required to do so by law.
CrestClean have a legal commitment to ensure your personally identifiable information will be held securely. You
have the right to change or access your information at any time. When this information is no longer required, official
CrestClean procedure will be followed to dispose of it.
Declaration
I, (Name) ___________________________________ have read and understand the privacy statement and agree
to my details being used for the purposes of becoming a Permitted Franchisee/Employee on Crest Commercial
Cleaning Limited customer sites.
Last Name:
First Name (preferred first name for ID):
Signature:
Today’s Date (DD/MM/YY):
Any queries regarding your privacy please contact Crest Commercial Cleaning Ltd
PO Box 740, Dunedin 9054 I Phone: 0800 273 780 I security@crestclean.co.nz
CrestClean ID Card & Privacy Declaration
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Request your own
criminal conviction history
You are asking for your criminal conviction history. Please fill out this form carefully and ensure all the information provided on
this form is complete and the identification provided is valid.
This form can be completed by typing in the fields or by writing in CAPITAL letters inside the boxes
using a BLACK or BLUE pen. Please post the completed, signed and dated form along with the copy of
your ID to: Criminal Record Applications, EX11064, Auckland, New Zealand.
The Information Management Group (NZ) Ltd will collect this request information and provide it to
the Ministry of Justice. All personal details relating to this request are removed from The Information
Management Group (NZ) systems 3 months from the date your request is processed.
Your personal details
Your personal details
Surname
First name
Middle names
Leave a space between names
Date of birth
Your gender  Male  Female
 Do not wish to state
New Zealand driver licence 
Make sure that the name and date of birth above matches that shown on the identification that you provide
with your application.
Previous names
Include maiden names and any other names you are known as, or have used
Surname
First name
Middle names
Surname
First name
Middle names
Surname
First name
Middle names
If you have a current NZ driver licence please enter
your licence number here
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Your postal/contact details
Please use a BLACK or BLUE pen and write in CAPITAL letters inside the boxes provided.
Street no.
Street name
Suburb
Town/city
State
Postcode
Country
Email
How do you want to receive your report? (Choose one)  Email  Mail
Home phone
Mobile 
Residential addresses
List below your current residential address (if dierent from above)
Street address:
Suburb:
Town/city
Postcode 
Country
List any other New Zealand addresses you have lived at in the past 10 years
Street address:
Suburb:
Town/city
Postcode 
Street address:
Suburb:
Town/city
Postcode 
Street address:
Suburb:
Town/city
Postcode 
Street address:
Suburb:
Town/city
Postcode 
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Your identification
Please attach a clear copy of your identity document from the list below (choose only one). It must show your
signature. Please tick the box below to show which type of document you are providing.
New Zealand driver licence – this must be current or can have expired within the last 2 years. We do not accept
cancelled, defaced or temporary licences.
New Zealand passport – this must be current or can have expired within the last 2 years. We do not accept cancelled
or defaced passports.
Overseas passports – this must be current and cannot be expired, cancelled or defaced.
New Zealand firearms licence – this must be current and cannot be expired, cancelled or defaced.
Proof of identity – If you do not have any of the above forms of identity, you may have someone complete a
“proof of identity” on your behalf. They must complete the Proof of Identity form which can be downloaded from
justice.govt.nz/criminal-records. This person must:
✓ have known you for more than 12 months
✓ be aged 18 years or over
✓ be contactable during business hours
✗ not be a relative (either by blood or marriage), and
✗ not live at the same address.
If you are unable to provide any of the above forms of identification, please go to justice.govt.nz/criminal-records
and complete a statutory declaration.
Full record of convictions
If you have any criminal convictions, they will not appear on your report if they meet the criteria under the Criminal Records
(Clean Slate) Act 2004. There are situations where you might be asked to provide a full record (e.g. some foreign countries
require this for visa purposes). The Ministry is only able to provide this to you and not to a third party.
Tick this box if you want to receive a full record.
Declaration
I have filled in this application myself
I had help filling in this form because I have a disability or language diculty
By signing this declaration:
I declare that the information I have given in this application is, to the best of my knowledge, true, complete and correct.
I understand if I have provided incorrect or incomplete information, the Ministry of Justice may not be able to provide an accurate
record of my convictions.
Sign & date your declaration below (the signature below must match the signature on your ID).
The Ministry of Justice does not process applications where the date of the signature is older than 6 months.
Signature Date signed
 
Full name
Service Standard: The Ministry of Justice aims to process all complete and correct requests within 3 working
days from receipt. This does not include postage time.
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
You will need to ask someone who can confirm your identity to be your identifier and fill in this form. You cannot fill in
this form on behalf of your identifier. Your identifier will also have to provide a valid copy of their identification.
Your identifier must:
✓ have known you for more than 12 months
✓ be aged 18 years or over
✓ have a daytime phone number that we can contact them on
✗ not be a relative (a relative is a person connected by blood or marriage), and
✗ not live at the same address.
This form may be filled in by the identifier by typing the information in the fields of the PDF or by printing
the form and completing it by hand using a blue or black pen.
Remember that the identifier must include a valid copy of their identification and the signature on this
identification must match the signature on this form.
Identifier details
Your surname
Your first name
Your middle names
(separated by commas)
 
Street address
Suburb
Town/City
Telephone
Email
I, the identifier, declare that I have personally known the applicant named below for
   
years and confirm this is
their identity.
Applicant’s surname
Applicant’s first name
Applicant’s middle names
(separated by commas)
 
Your signature
D D Y Y Y YM M
Date signed
     
Proof of identity
This form is for people who are requesting their criminal conviction history
and do not have valid identification.
Your identification
Please attach a clear copy of your identity document from the list below (choose only one). It must show your
signature. Please tick the box below to show which type of document you are providing.
New Zealand driver licence – this must be current or can have expired within the last 2 years. We do not accept
cancelled, defaced or temporary licences.
New Zealand passport – this must be current or can have expired within the last 2 years. We do not accept cancelled
or defaced passports.
Overseas passports – this must be current and cannot be expired, cancelled or defaced.
New Zealand firearms licence – this must be current and cannot be expired, cancelled or defaced.
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Your authority to release information
I aut
horise the Criminal Records Unit, Ministry of Justice, to provide me with the details of any
criminal convictions I may have which are held on the Ministry of Justice’s computer systems.
Your f
ull name:
Your
signature:
Date (DD/MM/YYYY)
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
208.20 Permitted Employee Application Pack © Crest Commercial Cleaning Ltd 2021
Employee Name
Employer (Franchisee)
I, (Franchisee name) ___________________________________________ understand the minimum employment
rights and obligations that apply by New Zealand law to me as an employer.
I have attached IRD Employer Registration confirmation letter
I confirm that I will provide relevant employment forms (IR330, KS2 and KS3) and will have a written employment
agreement with (employee name) ______________________________________________________________________ subject
to Immigration and Ministry of Justice Criminal background checks being satisfactory to Crest Commercial
Cleaning Ltd.
I confirm that I will pay my employees using below method;
(please tick one)
an online payroll system from the CrestClean approved list
I will use my Accountant to manage my payroll
If payroll is processed by my accountant, I acknowledge that payroll reports may be provided to Crest Commercial
Cleaning Ltd on a quarterly basis for ongoing audit and compliance checks.
Accountants Name Email address
I will meet my obligations as an employer.
Signed (Franchisee)
Date
Employment Declaration
A summary and further information about minimum rights and
obligations that apply by law, are available on the Ministry of
Business, Innovation and Employment’s website - click on this link:
Employment NZ: Minimum Employment Rights and Responsibilities
Employment NZ: Leave and Holidays (a guide to employees’ legal entitlement)
You will be sent a link to Employment eLearning
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Completed 9 May 2022

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