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Name *
Are you known by any other names?
Date of Birth *
Date of Birth
Gender *
Contact Phone (Mobile)
Contact Phone (Mobile)
Do you hold a NZ drivers licence?
Are you currently registered with Work and Income New Zealand?
Are you willing to obtain a DL9 medical certificate (for driver licensing purpose)
Please rate yourself in the following area
Please rate yourself in the following area
Please rate yourself in the following area
Do you require further literacy and/or numeracy help?
Upon the processing of this application you may be given an appointment/interview time at which you will need to bring with you, your full Birth Certificate or Passport and current New Zealand Drivers Licence. Please note that these must be original documents as we must view all originals before taking copies for our records. I declare that to the best of my knowledge all the information supplied on and with this application form, is true and complete, and I consent to the disclosure of personal information as described above. *