CDANZ SUBSCRIBERApplication forM

Mrs/Mr/Miss/Ms/Dr
Surname / Given Name / Middle Initial

Part A. Work Information:

Present Position: / Job Title:
Organisation:
Work: / Street/PO Box:
Suburb:
City & post code
Work Contact: / Phone:
Email:

Part B. Alternate/Home Contact Information for CDANZ

Home address:
Email:
Phone:
Tick box / If you want CDANZ newsletter & email to go to home/alternate email

Part C. Billing Address.Unless indicated below, your invoice will be addressed to you at your work address.

Tick box / If you want CDANZ invoice addressed to home address

Area:

Northland / Auckland / Waikato / Bay of Plenty
Hawkes Bay/Gisborne / Taranaki/King Country / Manawatu / Wellington
Nelson/Marlborough / Canterbury /Westland / Otago / Southland

Current work environment

School / Tertiary Institution / Government Agency / Corporate HR
Private Practice / Private Sector / NGO / ITO
Other (Please give details)

Current Career related services you provide (if any): (Please tick)

1X1 career counselling/coaching / Group work / CV writing / Professional Supervision
Providing Career Information / Teaching / Research / Vocational Rehabilitation
Consultancy / Recruitment / Vocational Assessment / EAP
Other (Please give details)

Tick how many hours per week you work in the Careers Industry (if any)

5 – 10 / 11 – 15 / 16 – 20 / 21 – 25 / 26+
Total years in the career industry to date (if any)

Ethnicity

New Zealand Maori / Iwi/Affiliations
New Zealand European/Pakeha / Pacifica / Asian / Other European
Other Ethnicity (Please give details)

Declaration:
 No

Yes / No / I give my consent for CDANZ National Executive Committee to release my name, phone number and e-mail
address to organisations with bona fide professional interests relating to career practice.
Yes / No / Do you have any criminal convictions, or are any charges pending, other than minor traffic infringements that in
any way impact on your ability to meet our Code of Ethics?
If so please describe:
Please note that if the Membership Officer has any concerns they will contact you for permission to do a Police Check.
I declare that if granted membership of the Career Development Association of New Zealand (Inc), I will uphold and abide by the Constitution, Ethical Code of Conduct and Rules of this Association. I confirm that the information contained in this application is true and accurate.
Signature:
Place: / Date:

A GST Tax Invoice will be emailed once your completed application form has been received.

TOTAL FEE WILL BE: / $ 97.50 incl GST

Please email your completed form to .An invoice will be emailed to you for payment.

If no access to email, please post to CDANZ, PO Box 31 104, Ilam, Christchurch 804