N.B.

PLEASE COMPLETE THIS FORM PAYING SPECIAL ATTENTION TO

ITEMS (b), (c) AND (d). PLEASE SUBMIT A TOTAL OF FOUR (4) PASSPORTSIZED PHOTOGRAPHS

TRINIDAD AND TOBAGO

IMMIGRATION REGULATIONS, 1974
APPLICATION FOR A WORK PERMIT OR AN EXTENSION OF A WORK PERMIT
TO:

The Permanent Secretary, Ministry of National Security

Note:

Applicants wishing to employ persons are requested to submit in respect of the respective employee twelve (12)
completed copies of this form to the Permanent Secretary along with the following:
(a)
The official receipt of the Comptroller of Accounts evidencing payment of the fee payable on application
for the work permit;
(b)
three (3) photographs of the prospective employee;
(c)
a police certificate with respect to the previous five (5) years;
(d)
two (2) written character references, one (1) of which must be from the last employer; and
(e)
in cases of extension, proof that all income tax due, has been paid.

1.

Full name: Dr. CHANDRASHEKHAR G. UNAKAL

Mrs..
Miss.

2.

Date and Place of Birth: 01/01/1978

3.

Present Nationality: INDIAN

4.

Previous Nationality: INDIAN

5.

Passport No.: J8299889

6.

Particulars of any change of nam.: - NIL -

7.

Permanent Address: DR. CHANDRASHEKHAR UNAKAL

AT; DASANUR
TALU: KALAGHATAGI
DISTRICT: DHARWAD-580114
KARNATAKA

8.

Marital Status: MARRIED

9.

Full name of wife: RASHMI KUSUGAL

Place and date of issue: BANGALORE, INDIA/ 19/08/2011.

10. Particulars of Children: 01 (6 Month old)

Name
Anvi
Chandrashekhar
Unakal

Date of
Birth
09/08/2014

Place of
Birth

Nationality

DHARWAD

INDIAN

Passport
Number
Applied at
Bangalore, India
App. Ref. No.
15-1000494089

Place and
Date of
Issue
Bangalore

11. Profession or occupation to be followed in Trinidad and Tobago: Lecturer in Microbiology, St. Augustine University.
12. State job experience, including on-the-job training
Ten Years of teaching and research experience in field of Microbiology
13. Whether accompanied by wife/husband: Yes, Rashmi Kusugal. Passport No. J7966061
14. Whether accompanied by children.: Yes, Anvi C. Unakal, Applied for Passport/ Appl. Ref. No. 15-1000494089
15. Date of arrival/intended arrival in Trinidad and Tobago (in relation to present application).: 10/April/ 2015

16. Local residential address.: I will opt for University furnished accommodation soon I arrive at Trinidad
17. Particulars of employment during the past five (5) years:
Employer
University of Gondar,
Ethiopia

University of Gondar,
Ethiopia

Karnataka University,
Dharwad, India

Employers
Address
Vice President
(Academic)
Post Box No. 196
University of Gondar
Ethiopia
Vice President
(Academic)
Post Box No. 196
University of Gondar
Ethiopia
The Registrar
Karnataka University,
Dharwad, India

Position
Held
Associate Professor in
Microbiology

Duration of
Employment
Feb 2013 to till date

Reason for
Termination
------

Assistant Professor in
Microbiology

November 2009 to
January 2013

Promoted to Associate
professor

Guest Lecturer in
Microbiology

January 2005 to June

2009

Appointed to
University of Gondar

18. Place/places of residence during the last ten (10) years preceding the application giving dates of such residence in each
country:

Dasanur, Taluk kalaghatagi, District Dharwad, Karnataka, Inida/ From birth till November 2009.
Univeristy of Gondar, Ethiopia / From November 2009 to till date

19. Particulars of income assured while employed in Trinidad and Tobago, (state salary, commission, perquisites and other
benefits):

Basic salary of TT$259,668.00 per annum

A special allowance of 6% of Basic salary
A transportation allowance of TT$ 3,250.00 per month

20. SCHOOLS/UNIVERSITIES ATTENDED:

Institution
Dates
From
To

Degree/Diplomas
Certificates Obtained

Dates
Awarded

(1) Secondary/High School:

June 1999 to June 2002

BSc.

June 2002

(2) University:

August 2003 to May 2005

MSc.

May 2005

(3) Other Courses:

June 2006 to September 2009

PhD.

September 2009

21. If to be self-employed give particulars of intended business on a separate sheet including financial circumstances with
documentary support and business references:
..
-----..
..
22. Has the prospective employee ever been deported or required to leave any other country?. No .
23. State offences (other than traffic offences) of which applicant has been convicted, if any, and give the date of conviction
in each case.
I, Dr. Chandrashekhar G. Unakal hereby declare that the foregoing particulars are true and correct.
..
Signature of Employee
Date
24. Capital formation of company including:
(a) percentage of capital owned by Nationals of Trinidad and Tobago
(b)

percentage of capital owned by Non-Nationals of Trinidad and Tobago who are residents...

(c)

whether subsidiary or affiliate of foreign-based company, and if so, name of parent company.