OFFICE USE ONLY Client no.: Date received: / / Application no.

August 2024 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 unless the person you employ is applying
agreements on the employer’s behalf. Please answer all for a Specific Purpose work visa under the Seasonal Workers
questions. If any question does not apply please answer subcategory.
“N/A” for “not applicable”. Complete this form if you are Providing this information will help us to process the application,
an employer who has offered a position to a person from however we may need to contact you for more information.
overseas who is applying for a work visa or varying the
conditions of a work visa. Submit photocopies only. Do not submit original documents
as they will not be returned to you. If we need to see an
This form must be used for:
original document we will ask you to produce it at a 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 a
• Specific Purpose work visa applicants, where a job offer person who is not entitled to work in New Zealand. One way for
is required; and employers to avoid committing this offence is to check a person’s
entitlement to work through Immigration New Zealand’s online
• Variation of Condition work visa applicants
VisaView system. For more information or to register please visit
This form is not required for any other work visa category. www.immigration.govt.nz/visaview. Disclosure of information
This form must be submitted by the person you have offered through VisaView is authorised by legislation.
a position to with the Work Visa Application (INZ 1015) form
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

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

A2 Full name of person completing this form.

Position or title of person completing this form.

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

Telephone (daytime) Telephone (evening)

Fax Email

Website Mobile

A3 New Zealand Business Number For help search: www.nzbn.govt.nz

A4 Do you hold current accreditation under the Accredited Employer Work Visa (AEWV) category? Yes No

A5 How long has this business been in operation?

A6 How many people does the business currently employ?

A7 How many current employees are New Zealand citizens or residence class visa holders?

A8 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

A9 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).

2 – Employer Supplementary Form – August 2024 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

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 ANZSCO occupation code

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

B4 The type of work, duties and responsibilities.

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

B6 Hours of work.

B7 The duration of the job.

B8 Qualifications required.

B9 Type of experience required.

Length of experience required.

B10 Other skills or competencies required.

Employer Supplementary Form – August 2024 – 3

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

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
B12 Are you seeking to employ a migrant under the Specific Purpose work visa Seasonal worker subcategory?
Yes If yes, go to B13.

No If no, go to section C.

B13 Have you advertised the role for at least 2 weeks on a general national job listing website?
Yes If yes, go to B14.

No If no, you must advertise the role for 2 weeks prior to the employee applying for a work visa.

B14 What evidence of advertising the role has been provided?

4 – Employer Supplementary Form – August 2024

 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.

DD MM YYYY
Signature Date

Name Job title or position

Employer Supplementary Form – August 2024 – 5

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

6 – Employer Supplementary Form – August 2024