APPLICATION FOR EMPLOYMENT

SEASONAL/SUPPLEMENTARY STAFF APPLICANTS ARE TO COMPLETE SECTIONS 1, 3 AND 4 ONLY

(PLEASE COMPLETE FORM IN CAPITAL LETTERS)

SECTION 1

1. TERRITORY OF EMPLOYMENT: BARBADOS GUYANA TRINIDAD & TOBAGO

2. ___________________________________________________________________________________

TITLE (MR/MS/MRS) SURNAME FIRST NAME OTHER NAME(S):

3. DATE OF BIRTH (DD/MM/YYYY): ________________________________________________________

4. ADDRESS: _________________________________________________________________________

___________________________________________________________________________________

5. EMAIL ADDRESS: _____________________________________________________________________

6. TELEPHONE NOS: ___________________ (h) ____________________ (c) ______________________ (other)

7. IDENTIFICATION NUMBER/NATIONAL REGISTRATION NUMBER: ________________________________

8. TAX REGISTRATION/TAMIS NUMBER: _____________________________________________________

9. NATIONALITY: ________________________________ 10. RESIDENCY/CITIZENSHIP: YES NO

11. NATIONAL INSURANCE SCHEME NUMBER? _______________________________________________

12. HAVE YOU WORKED PREVIOUSLY FOR CXC? YES NO

IF YES, PLEASE STATE THE MOST RECENT YEAR: _____________ ACTIVITY: _____________________

13. KINDLY INDICATE THE ROLE(S) FOR WHICH YOU ARE APPLYING AND ARE QUALIFIED:

Examining Processing Supervisor Senior Data Entry Finalizer Senior General Worker/Porter

Examining Processing Assistant Data Entry Operator General Worker/Porter

SECTION 2

FOR CXC USE ONLY

DATE OF EMPLOYMENT: EMPLOYEE NUMBER: ACTIVITY:

ENTERED INTO DATABASE: LOCATION: TAX CODE:

SCREENED: AVAILABLE FROM:

ACTION COMPLETED BY: INITIAL(S): DATE:

…/2

FRM/HRD/0012

JAMAICA

…/3

SECTION 3

14. EDUCATION/QUALIFICATIONS

Please provide details of your education below:-

Details of Educational institutions attended:-

LEVEL NAME OF

SCHOOL/INSTITUTION

ADDRESS YEARS

ATTENDED

PRIMARY

SECONDARY

TERTIARY

1.

Course Title:

2.

Course Title:

QUALIFICATIONS OBTAINED

YEAR SUBJECT EXAMINING BODY LEVEL GRADE

15. WORK EXPERIENCE

Please provide details of your work experience below:-

EMPLOYMENT PERIOD ORGANISATION POSITION

13. TRAINING

Please provide details of your training below:-

YEAR TRAINING INSTITUTION COURSE RESULT/

GRADE

14. ACHIEVEMENTS/EXTRA CURRICULA ACTIVITIES/HOBBIES

Please provide information on your achievements etc below:-

SCHOOL

WORK

OTHER

…/4

SECTION 4

15. Please indicate below any allergies or medical conditions:

ALLERGIES: MEDICAL CONDITIONS:

16. In case of emergency, please contact:

Name:

Relationship:

Address:

Telephone: (h) (c) (w)

17. Please date and sign your application below.

I, the undersigned, certify that the information provided in this application, is true, accurate and complete to the best of my knowledge, and that the documents submitted along with this application form are genuine. I agree to be bound by the policies, procedures and rules of the organization.

DATE OF APPLICATION SIGNATURE OF APPLICANT

FOR CXC USE ONLY – DOCUMENTS PRESENTED – tick as appropriate

Documents Submitted:

National ID Card/Birth Certificate/Passport

National Insurance Card

Police Certificate of Character

Proof of Valid Bank Account

Original Certificates or Statements Verified

Letter of Character Reference Proof of Address

Medical Certificate of Fitness

Other(s): (please state)

Revised: March 2019 © Human Resource Department