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    Inz1113 240522192

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    Edwinjoy Alrin
    This document is an employer supplementary form that must be completed by employers offering jobs to overseas workers applying for work visas in New Zealand. The form requests information about the employer's business and the job offered, including details about the position, pay, qualifications and experience required. It also contains a declaration that the employer must sign verifying the accuracy of the information provided.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Inz1113 240522192

    Uploaded by

    Edwinjoy Alrin
    14 views6 pages
    This document is an employer supplementary form that must be completed by employers offering jobs to overseas workers applying for work visas in New Zealand. The form requests information about the employer's business and the job offered, including details about the position, pay, qualifications and experience required. It also contains a declaration that the employer must sign verifying the accuracy of the information provided.

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    inz1113 240522192

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    This document is an employer supplementary form that must be completed by employers offering jobs to overseas workers applying for work visas in New Zealand. The form requests information about the employer's business and the job offered, including details about the position, pay, qualifications and experience required. It also contains a declaration that the employer must sign verifying the accuracy of the information provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views6 pages

    Inz1113 240522192

    Uploaded by

    Edwinjoy Alrin
    This document is an employer supplementary form that must be completed by employers offering jobs to overseas workers applying for work visas in New Zealand. The form requests information about the employer's business and the job offered, including details about the position, pay, qualifications and experience required. It also contains a declaration that the employer must sign verifying the accuracy of the information provided.

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    You are on page 1of 6

    OFFICE USE ONLY Client no.:240522192 Date received:2024 /05 /10 Application no.

    :A3612801

    June 2022 INZ 1113

    Employer Supplementary
    Form
    for employers who have offered a position
    to a person from overseas who is applying for a work visa

    Information for employers


    This form must be completed and signed by a person who Note: If you are an Accredited Employer, you do not have to
    has authority to make representations and enter into complete this form.
    agreements on the employer’s behalf. Please answer all Providing this information will help us to process the
    questions. If any question does not apply please answer application, however we may need to contact you for
    “N/A” for “not applicable”. Complete this form if you are more information.
    an employer who has offered a position to a person from
    overseas who is applying for a work visa or varying the Submit photocopies only. Do not submit original documents
    conditions of a work visa. as they will not be returned to you. If we need to see
    an original document we will ask you to produce it at a
    This form must be used for:
    later time.
    • Work to Residence: Long Term Skill Shortage List (LTSSL)
    work visa applicants; and Work entitlement
    • Post-study work visa (employer assisted) applicants; and It is an offence under the Immigration Act 2009 to employ
    • Specific Purpose work visa applicants, where a job offer a person who is not entitled to work in New Zealand. One
    is required; and way for employers to avoid committing this offence is to
    check a person’s entitlement to work through Immigration
    • Variation of Condition work visa applicants
    New Zealand’s online VisaView system. For more information
    This form is not required for any other work visa category. or to register please visit www.immigration.govt.nz/visaview.
    This form must be submitted by the person you have offered Disclosure of information through VisaView is authorised
    a position to with the Work Visa Application (INZ 1015) form by legislation.
    or the Application for a Variation of Conditions or Variation
    of Travel Conditions (INZ 1020) form.

    About the information you provide


    Immigration New Zealand collects the information about you Immigration New Zealand may also share the information
    on this form to determine your request to recruit overseas you have provided with other government agencies that
    workers. We may also use the information to contact you for are entitled to it by law, or with other agencies (as you have
    research purposes or to advise you on immigration matters. agreed in the declaration).
    The address of Immigration New Zealand is PO Box 1473, You have the right to access the information we hold about
    Wellington 6140, New Zealand. Do not send your application you and have any of it corrected if you think it is necessary.
    to this address.
    For more information
    Collecting the information is authorised by the Immigration Act
    2009 and the Immigration Regulations made under that Act. If you have questions about completing this form:
    You do not have to provide the information, but if you do not • see our website www.immigration.govt.nz
    we are likely to decline your application. • telephone our call centre on 0508 558 855 (within New Zealand).

    immigration.govt.nz
    When filling in this form, please write clearly using CAPITAL LETTERS.

    Section A Employer details


    Please complete the following:

    A1 State the name of the person to whom you have offered a position in your business
    Family/last name Given/first name(s)
    THENUWARA ARACHCHILAGE HARSHANI AKALANKA

    A2 Full name of person completing this form.


    JACO KRIEK

    Position or title of person completing this form.


    HR MANAGER

    Business name (if applicable) and physical and postal addresses.

    RADIUS CARE LIMITED LEVEL 4 56 PARNELL ROAD PARNELL AUCKLAND 1052

    Telephone (daytime) 93041670 Telephone (evening)

    Fax Email

    Website Mobile

    A3 New Zealand Business Number 9 4 2 9 0 3 1 3 4 0 2 6 7 For help search: www.nzbn.govt.nz

    A4 How long has this business been in operation? 14 years

    A5 How many people does the business currently employ? 315

    A6 How many current employees are New Zealand citizens or residence class visa holders? 315

    A7 Has the business made anybody redundant, or been through a consultation with respect to potential
    redundancies, in the past six months?
    Yes Provide details, including how many people were affected and their roles. No

    A8 State the names of any associated companies or businesses (such as parent or subsidiary companies, and
    companies associated with substantial owners or directors of this business).

    Aaron SNODGRASS
    Brian MALTBY
    Simon CURRAN
    Frances VALINTINE
    Peter ALEXANDER
    Jonathan MASON

    2 – Employer Supplementary Form – June 2022 This form has been approved under section 381 of the Immigration Act 2009.
    Section B Position details
    Provide details of the position you have offered to the potential employee named in this application.

    B1 Job title HOME ASSISTANT

    B2 ANZSCO occupation title, occupation code, and skill level (ANZSCO is the Australian and New Zealand
    Standard Classification of Occupations. Most New Zealand occupations are listed in the ANZSCO, with
    a six-digit occupation code and a skill level ranging from 1 (highly-skilled) to 5 (unskilled). For more
    information see www.immigration.govt.nz/anzsco.

    ANZSCO occupation title HOME ASSISTANT ANZSCO occupation code 4 2 3 1 1 1

    B3 The address of the place of employment (if different from that stated in question A2 ).

    B4 The type of work, duties and responsibilities.


    Ensure clients receive their medication on time
    Support clients who cant move on their own
    Help clients dress, bathe, eat etc.

    B5 Details of pay and conditions of employment (for example, holidays).


    NA

    B6 Hours of work. 8 HOURS PER DAY

    B7 The duration of the job. 2 YAERS

    B8 Qualifications required.
    NOT REQUIRED

    B9 Type of experience required.


    NOT REQUIRED

    Length of experience required. NOT REQUIRED

    B10 Other skills or competencies required.


    NOT REQUIRED

    B11 Does the worker require occupational registration in New Zealand?


    Yes T he applicant will need to produce evidence that this has been obtained at the time of submitting the work visa application.
    No

    Employer Supplementary Form – June 2022 – 3


    When filling in this form, please write clearly using CAPITAL LETTERS.

    Section C Declaration by employer


    This section must be read and signed by a person who has authority to make representations and enter into
    agreements on the employer’s behalf.
    I understand the notes and questions in this form and I declare that the information given about my business
    is true and correct.
    I understand that further information relating to business records, sets of accounts, financial statements and
    other records deemed necessary may be requested.
    I understand that if I make any false statements, or provide any false or misleading information, or have
    changed or altered this form in any way, that I may be committing an offence under sections 342 and 348 of
    the Immigration Act 2009 and may be liable to prosecution.
    I agree to inform Immigration New Zealand about any relevant changes to the circumstances of my business
    that occur after I lodge this form that may impact on current or prospective applicant’s employment.
    I authorise Immigration New Zealand to:
    • seek information concerning my compliance with New Zealand’s immigration and employment laws from
    any records held by the Ministry of Business, Innovation and Employment
    • make any enquiries it deems necessary in respect of the documents or information provided in respect of
    this form
    • share information provided about me or my business with other government agencies (including overseas
    agencies) to the extent necessary to make decisions.

    Signature Date 1D 0D 0M M5 2Y 0Y 2Y Y4

    Name JACO KRIEK Job title or position HR MANAGER

    4 – Employer Supplementary Form – June 2022


    Employer Supplementary Form – June 2022 – 5
    When filling in this form, please write clearly using CAPITAL LETTERS.

    6 – Employer Supplementary Form – June 2022

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