Pass Port Photo

Employee Application Forms

Each Employee information is subject to a background check and any information given that is of an untruthful
nature this individual will be immediately dismissed if hired.

Name:_____________________________________________________________
Address:

Date of Birth____/____/____

National id card No._________________

NIS. No__________________________
Phone No:____________ Home: _____________ Cell:_______________
Have you ever been convicted of any crime: Yes No
(If yes Please state the nature of it)

Education
Tick your highest level of schooling

Primary
Subject

Secondary
Grade

Trade School

University
Subject

Major

Degree
Grade

Work Experience
State two of your most recent place of work

Job #1
Company Name

Address

Phone No.

Supervisor Name

Job #2
Company Name

Address

Phone No.

Supervisor Name

Could we call your last employer to find out more about you: Yes No
Can you use a: Brush-Cutter: Yes No
Power Washer: Yes No
Please state your skills and briefly tell us how it will benefit our company:
______________________________________________________________________________________________________

Important Personal Information

Are you : married

Single

Divorced

Do you have children: Yes / No How many _______________

Widowed

How many Dependants do you have ___________

Do you have someone to properly take care of your kids if they are under the age of 18 years of age while u are at
work :
Yes
No
Are you able to work : Full time

Part time

Are you able to lift 50lb or more Yes

Do you have any known medical illness Yes
Are you on any medication:

Yes

On Call

No
No

(if yes please State)_______________________

No

Do you have a First Citizen bank account (if yes place your account no. )