Candidate Registration

Have you ever been convicted of a criminal offence or aware of a pending hearing, relating to charges, for any such criminal conviction? You are not required to inform us if your conviction is covered by the criminal records (Clean Slate) Act 2004.

Is there any pre existing condition or medical history that may affect your ability to perform duties in the role or any future role you may apply for?

I certify that the information provided on this medical history form is accurate and truthful. I understand that failure to advise Fusion partners of any relevant information may result in termination of any representation and withdrawl of any job applications. I agree to immediately advise Fusion Partners if any information provided changes

Please provide a minimum of two referees, to whom you have directly reported. (we will not contact referees without prior discussion and ensuring you have advised them we will be in contact).


I acknowledge that personal information provided to Fusion Partners, for the purpose of assessing my suitability for any position. I authorise Fusion Partners to:

• Obtain background checks, from sources relevant, including police, credit and reference checks.
• Disclose such information to the potential employer/ organisation directly, either verbally or in writing.
• Undertake relevant skills or psychometric assessments to potential employers.

I authorise Fusion Partners to retain my details on file and discuss my work history, background checks and any relevant information provided with any agreed organisations for any relevant positions.

I understand that comments made by my nominated referees in confidence will not be discussed with to me.

I certify that the information I have provided in this application and associated documents, ,including my CV/work history and any information discussed during interviews, is truthful and accurate.

I additionally confirm that I have not withheld any information relating to my health, , eligibility to work in New Zealand or criminal convictions that would be relevant to Fusion Partners and any future employer when assessing my potential employment.

I understand that if I or any other person, provided or omits relevant information, pertaining to my application, Fusion Partners reserves the right to exclude my application and may not represent me for future opportunities. I dually acknowledge that my employment may be terminated if, following investigation, any employer discovers I have provided false or misleading information.

I hereby acknowledge that during my interactions with Fusion Partners,I may be privy to confidential information relating to Fusion Partners and their client’s. Further, I may receive, or have documents/information shared, which at all times is to remain the property of Fusion Partners and it’s clients exclusively. I understand and agree not to, under any circumstances, disclose or retain information or intellectual property, which I obtain during such interactions.

I confirm that all information in this application is truthful and accurate, to the best of my knowledge and authorise Fusion Partners to represent me.