EMPLOYEE APPLICATION

Department        :    Human Resources

Subject              :    EMPLOYEE APPLICATION

The following information will help us to assess your employment opportunity with XXXXX XXXX XXXXX ( hereinafter  called the “Employer” ). All portions of this application pertaining to you must be completed. We appreciate the time you spend completing this application form.

Recent Photograph 4 X 6 cm

Position                                               : _____________________________

Other position (s) you would like to be considered for     : _____________________________                            

Salary Expectation                                      : _____________________________

Date available to start                                 : _____________________________

PERSONAL DATA

Full Name:                                               ™ Male                    ™ Female

Address    :

City     :                                                    Post Code:                   Telephone:

I.D. Card Number:                                      Marital Status:

Height / Weight                                          Blood Group  :             Distinguishing Marks:

EDUCATION AND TRAINING

Name and address of school, university or other training institutions.	From Date	To Date	Major Course or Study	Degree or Certificate

RECORD OF PREVIOUS EMPLOYMENT

1. Company Name: _____________                  Telephone: ______________

     Address:             _____________                  Position:     ______________

     Nature of Business:   _____________________________________

     Employment dates:   From _____   To _____  Supervisor’s name : ________________

     Wage / Salary rate:   Start _____    End ____

     Reason for leaving: _____________________

2.  Company Name: ______________                Telephone: ___________________

     Address:   _____________________                  Position: _____________________

     Duties:

     Nature of Business:_______________________

     Employment dates:   From _____   To _______   Supervisor’s name :

     Wage / Salary rate:   Start _____    End ______

     Reason for leaving: _______________________

3. Company Name: ______________                Telephone: ___________________

     Address:   _____________________                  Position: _____________________

     Duties:

     Nature of Business:_______________________

     Employment dates:   From _____   To _______   Supervisor’s name :

     Wage / Salary rate:   Start _____    End ______

     Reason for leaving: _______________________

REFERENCES (Non – Relatives )

1. Name:____________Telephone:____________     Occupation :  ___________Years known : ________

     Address :__________________________   

2.  Name:____________Telephone:____________     Occupation :  ___________Years known : _________

     Address :__________________________   

3.  Name:____________Telephone:____________     Occupation :  ___________Years known : _________

     Address :__________________________   

LANGUAGE PROFICIENCY

Language Skills (Language Spoken) :            

I speak fluently                                                   I speak a little

FAMILY RECORD

Father’s Name          :                                 Age :                 Occupation :                              

Mother’s Name    :                                 Age :                 Occupation :                         

Permanent Address                                City :                 Telephone   :

Husband/Wife’s Name                            Birth Date :         Occupation :

First Child :                                           Birth Date :         Sex :  Male      œ Female

Second Child :                                       Birth Date :         Sex :  Male      œ Female

Third Child :                                          Birth Date :         Sex :  Male      œ Female

GENERAL INFORMATION

Are presently employed ?              œYes             œ No

Have you ever been discharged from employment ? If yes, please explain.

Have you any objection to our contacting your previous employers ?      œYes          œ No

Have you had any serious illnesses, injuries or operations within the last five (5) years? If so, please describe.

Do you have any obvious tattoos?                œYes                 œNo

Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working within the company ?             œYes                 œNo

If yes, who ?  (1)                                     (2)                                          (3)                                        

Have you ever suffered from any of the following illness?

     Tuberculosis            œYes                 œNo              Heart Disease      œYes                 œNo

     Hypertension           œYes                 œNo              Diabetic             œYes                 œNo

     Venereal Disease      œYes                 œNo              Epilepsy             œYes                 œNo

     Hepatitis                 œYes                 œNo              HIV/AIDS Virus    œYes                 œNo

DECLARATION:

I certify that all statements made on this application are true and complete to the best of my knowledge. I understand that misrepresentation or omission when discovered, will subject me to discharge and I hereby authorize any investigation relating to my work experience, education, or reputation for the purpose of my application for employment.

Applicant' Signature                                                                   Date