Prospect Form
Please read this information before completing this form.
We are committed to protecting your privacy and maintaining confidentiality, and also to using the information you have provided to help match you to suitable job opportunities.
Important information about your personal details:
Sometimes we need to talk to people such as previous employers, job referees, referring agencies and training organisations to help us build a picture of your skills and abilities. We will always get your permission before contacting anyone for this purpose.
We may also need to talk to potential employers when looking for suitable work for you. Again, we will get your permission first.
The work we do to try to find you suitable employment is generally paid for by another organisation such as the Ministry of Social Development (MSD), ACC or an insurance company. They require us to provide them with information about the services we have provided to you and to notify them if you are employed through our employment service.
They may contact you to confirm you have received services from us.
We sometimes use independent companies to undertake customer surveys on our behalf.
You may be contacted by one of these companies and invited to take part in a survey about the quality of our services. Of course you don’t have to participate, and you can opt out of future contact
Your personal information is stored by Workbridge electronically. We have comprehensive security arrangements in place that protect against loss or misuse of your personal information.
You can access the information we hold about you at any time, you just need to ask.
You can ask us to change any information we hold about you that is not correct.
Eligibility Check
Confirm Eligibility
You are currently living in New Zealand.
You are a New Zealand citizen or permanent resident.
You are aged between 16 to 64 years old inclusive.
You have a disability or health condition that is likely to impact on your ability to work for six (6) months or more.
Exceptions to Eligibility
You qualify for vocational rehabilitation from the Accident Compensation Corporation (ACC)
You are being provided vocational services by the Ministry of Health.
You are enrolled at a secondary school
If you don't meet these conditions, need help with the form, or are unsure if you might qualify, please contact our friendly team on:
Phone: 0508 858 858 (between 8:30am and 6:30pm, Monday to Friday)
Email: registeronline@workbridge.co.nz
Relationship with Work and Income
Please select one of the following statements that apply to you
You are receiving a benefit, or your partner is receiving a benefit.
You have applied for and been assessed as eligible for a benefit.
You were receiving a benefit that has been cancelled because you started work.
You have applied for a benefit but need to complete pre-benefit activities.
You have contacted Work and Income or Workbridge for assistance to obtain or remain in employment in addition to support provided by Work and Income.
You are not receiving a Supported Living Payment (sickness, injury or disability) because you are on a work trial with the agreement of Work and Income for a period of time.
You will be applying for a Supported Living Payment (sickness, injury, or disability, or total blindness).
You are receiving New Zealand Superannuation or a Veteran's Pension as a non-qualified spouse or partner.
I have no relationship with Work and Income
Covid Information
Covid Vaccination Status
Please select...
You are fully vaccinated (you have received two vaccinations)
You have received your first vaccination and are scheduled for/intend to receive a second
You are unvaccinated (you have had no vaccinations)
You do not wish to disclose your vaccination status
Personal Details
Title
Please select...
Mr.
Ms.
Mrs.
Miss
Dr.
Prof.
First Name
Middle Name
Last Name
Email
Mobile
Phone
Birthdate
Gender
Please select...
Male
Female
Gender Diverse
Unknown
Street Address
Suburb or Town
City
Zip/Postal Code
Preferred Contact Method
Please select...
Email
SMS/Text
Mobile Phone
Other Phone
TTY
Via Agent
Residency Status
NZ Citizen
Permanent Resident of NZ
SWN Number
How did you find out about us?
Please select...
Community Event
Facebook
Family or Friend
MSD/Work and Income
Newspaper
Other Workbridge Jobseeker
Social media (other than Facebook)
Walking past a Workbridge office
Workbridge Website
Website other than Workbridge
Other (specify other)
ACC
Blind Foundation
Brain Injury Society
CCS
Church
Deaf Association
Direct Referral
Disability Agency
Employer
Epilepsy NZ
IHC
Iwi Provider
Mental Health Agency
Other Agency
Pacifica and Migrant Group
Police and Corrections (EG Probation)
Rehabilitation Centre
School
Self
Supported Employment Agency
Tertiary Provider
Training ITO
WB Centre
Yellow Pages
Autism NZ
Radio
MSD Region
Please select...
Auckland
Bay of Plenty
Canterbury
Central
East Coast
Nelson, Marlborough and West Coast
Northland
Southern
Taranaki, King Country and Whanganui
Waikato
Wellington
MSD Site
Please select...
Albany
Avondale
Birkenhead
Browns Bay
Clendon
Glenfield
Glen Mall
Great Barrier Island
Grey Lynn
Helensville
Highland Park
Hunters Corner
Mangere
Manukau
Manurewa
Mt Albert
Mt Eden
New Lynn
Onehunga
Otahuhu
Otara
Papakura
Papatoetoe
Pukekohe
Queen Street Auckland
Takapuna
Tamaki
Three Kings
Waiheke Island
Waitakere
Waiuku
Wellsford
Westgate
Greerton
Kawerau
Mt Maunganui
Murupara
Opotiki
Rotorua
Taupo
Tauranga
Te Puke
Tokoroa
Turangi
Whakatane
Akaroa
Ashburton
Cheviot
Hornby
Kaiapoi
Linwood
New Brighton
Oxford
Papanui
Rangiora
Riccarton
Shirley
Sydenham
Dannevirke
Featherston
Feilding
Foxton
Horowhenua
Kapiti Coastlands
Otaki
Pahiatua
Palmerston North
Wairarapa/Masterton
Flaxmere
Gisborne
Hastings
Kaiti
Napier
Ruatoria
Taradale
Te Araroa
Tokomaru Bay
Waipukurau
Wairoa
Blenheim
Greymouth
Hokitika
Kaikoura
Motueka
Nelson
Richmond
Stoke
Takaka
Westport
Dargaville
Kaikohe
Kaitaia
Kamo
Kawakawa
Kerikeri
Onerahi
The Pulse
Whangarei
Alexandra
Balclutha
Dunedin
Dunedin South
Farlie
Geraldine
Gore
Invercargill
Lumsden
Mosgiel
Oamaru
Queenstown
Riverton
Timaru
Hawera
Marton
New Plymouth
Ohakune
Stratford
Taihape
Taumaranui
Te Kuiti
Waitara
Whanganui
Cambridge
Coromandel
Dinsdale
Five Cross Roads
Glenview Shopping Centre
Hamilton
Hamilton East
Huntly
Matamata
Morrinsville
Ngaruawahia
Paeroa
Te Awamutu
Thames
Waihi
Johnsonville
Kilbirnie
Lower Hutt
Naenae
Newtown
Porirua
Upper Hutt
Wainuiomata
Wellington
Other Source
Nearest Workbridge branch to you?
Please select...
Auckland
Auckland - North Shore
Blenheim
Canterbury
Dunedin
Gisborne
Hawkes Bay
Nelson
Northland
Oamaru
Palmerston North
Rotorua/Taupo
Southland
Taranaki
Tauranga
Timaru
Waikato
Wellington
West Coast
Whanganui
Status
Please select...
Unqualified
New
Working
Nurturing
Qualified