PERSONAL INFORMATION (Please make sure to fill out the application completely and neatly.)

Name: / Date: / /

Last First Middle dd/mm/yy (today’s date)

Present Mailing
Address / PO Box: / Post Code: / Home Phone: / Cell Phone:
Present Street
Address: / Email
Address:
Date of Birth: dd/mm/yy
/ / / Gender:
Male / Female / Nationality: / Please circle the following that apply:
Residency with Right to Work / Married to Caymanian /
Cayman Status / Work Permit Holder
PLEASE PROVIDE PROOF OF STATUS/CITIZESHIP.
Emergency
Contact / Name: / Relation: / Phone:

GENERAL INFORMATION – Necessary to process your application

Position applied for: / Date Available: / Salary:
Are you currently employed?
Yes / No / If Yes, May we contact your employer?

Yes / No

Have you applied to PDL or
Foster Brothers before? Yes / No / If Yes, when?
Do you hold a valid drivers License:
Yes / No / If Yes, where was it issued?
License Class / Group: / License #: / Expiry Date:

EDUCATION Name & location of School Level Completed Did you Graduate?

Grammar
School
/
Yes / No
High
School /
Yes / No
Other /
Yes / No

Please write 25 words or more, why you would like to work at PDL and why would you make a good employee.

Signature: ______

FORMER EMPLOYERS – List your last three employers

dd/mm/yyyy / Name & Address / Phone / Final Salary / Position / Reason for Leaving
From:
To:
From:
To:
From:
To:

REFERENCES – Give the names of three persons not related to you, whom you have known for at least one year.

Name / Address / Phone / Business / Years Known
PHYSICAL RECORD AND ADDITIONAL INFORMATION
How did you find out about this job? 1)Compass Ad or 2)Referral
Do you have a physical or medical condition, which may limit your ability to perform the job applied for? Yes / No
Would you be prepared to take random Drug Tests? Yes / No
Have you ever been charged or convicted of any felony or drug related crimes? Yes / No
If Yes, Please explain:
Do you have any pending felony or drug related charges? Yes / No
If Yes, Please explain:
Can you work on weekends and Public Holidays? Yes / No

I hereby authorized investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts call for is cause of dismissal.

Signature: ______ Date: ______

Interviewed by: ______Date: ______

Remarks: ______

Neatness / Ability / Character / Personality
Hired / Department / Position / Will Report / Salary

APPROVALS

Personnel Manager / Department Head / Managing Director

RAP:18/02/11

Application Form Checklist

In order to expedite your application efficiently, we ask that you complete the application form provided in BLOCK CAPITALS. The following information below will be provided along with your application form. INCOMPLETE and INCORRECT information of your application will result in your application not being processed.

Please check the boxes that applies to you below:

Caymanian / Caymanian Status / Residency with the Right to Work
Copy of your valid passport / q
Copy of your Birth Certificate or your Caymanian Status Certificate or Residency Certificate / q
Copy of Police Clearance Certificate issued within the last 3 months / q
Copy of valid Cayman Islands Driver’s License (if applicable) / q
Married to Caymanian
Copy of your valid passport / q
Copy of your Marriage Certificate / q
Copy of your Spouse’s Birth Certificate or your Spouse’s Caymanian Status Certificate / q
Copy of Police Clearance Certificate issued within the last 3 months / q
Copy of valid Cayman Islands Driver’s License (if applicable) / q
All Other Applicants
Copy of your valid passport / q
Copy of Police Clearance Certificate issued within the last 3 months / q
Copy of valid Cayman Islands Driver’s License (if applicable) / q