REPUBLIC OF ZAMBIA ‘The Immigration and Deportation Act, 2010 (Act No. 18 of 2010) ‘The Immigration and Deportation (General) Regulations, 2011 APPLICATION FOR AN EMPLOYMENT PERMIT. (Section 28 ofthe Immigration and Di Please complete in block letters (@) Samame Other names in fal Ser (Tick () ae applicable Date of bith (44/mny Place of birth ‘Naticnali sort NG, Place of issue (©) Dato of sie (amy (@)Dateof expiry (fam yy ‘Occupation “Addressin coumiry Of permanent residence (@) Physical address (@) Postal adarose (Telephone No,/Mobile No, (@) Emait ‘Countries resident “Town Tanwara, ve Highest education standard attained (Attach cetiied copy ofeach certificate obtained) ration Act, No. 18 of 2010) PARTI PERSONAL DETAILS 'o be completed by applicant Mensch Joseph Kwamina Male Oh March 1976 ‘Town | Kemeda [Ghanaian [a2647677 Accra: Vain October 27S 1 Miring Equipment Electrician Kakoradi, Komenda, Ghana immediatel ‘Coun ZAMBIA @)_Baucation Professional/ Technical Tnsttution ication obtained Form 20a (Gogulaton 27)11. | Previous relevant work experience ‘Name of Employer Nature of employment Period of employment Crew Gold Mine Eotrical Supervisor 201-2014 12. | Dees your spouse or parent hold an VeSOrs parmitT ‘B. | If youranswer to questions yes, please provide the Investor's Permit No, 11) Hate You ever applied fora pornitunder We tinmigjafon and Deponaton ACL D0 othe Tmmigiavon and Deportation Act, Cap. 123? Ifyes, give detaila ‘Pormit applied for Date of application Satis of application (pending, {ranted or rected) “Temporal Port T5520. Granted “Employement Perit 99-2020, rejected (b) TF the application was rejected, state reasons for rejection: FRIRGIRT TOT GaTRTUGY 10 ake ver 3S. | Have yeu or your spouse ever ben este fiom eiaring ay sos crap ‘epetrated from aay country? IF yes, give details below ‘Country in which entry rsiricted or | Year of reairiction, depariation Reasons from which deported or repatriated repatriation NA NA 16. | Have you Been convicted ofan offence under any law within or oubie Zama? yea Spe tl DSW ‘Nature of offence: ... Nf Date of conviction: Sentence: 17, | Areyou unr in English or any nguage indigenous to Zambia? Tiyes ck MageaesOP PARTI FAMILY DETAILS: T_[Martal states Single |_| Marsied |X| Widowed | | Separated] Divowad 29, | Full names of spouse [itmarried) | Sursame Bisst Name 720. | Date and country oF birth of spause (a)_Date of birth (édmmy/ yw) (b| Place of bireh (0) Town and country of Gh ‘21. | Number of cildren/dependanis @ | Chien Dependanis Particulars of chien Name Sex| Dateobinh [Phos of tinh (@e/mm/yyyy) _| (Town ane country) 2. | Particulars of dependants Name Se) Datofbinh | Pie of [ Append Two recent pasporl siz photogs[ Centfed copy of carrent passport Certified copy of each academic and professional coisa bined Latter of offer of emplayment/ Contract of employment Cotifiod copy of marrioge certificate applicable Contfid copy of birth cerficae ofeach child/ dependant DECLARATION hereby declare tht the information fanished by me ints application is true, corectand complo to the best oly. Inewledge Teastrstand that any incorrect miscading or unt information or the withholding of any relevant information may aifect the isuance of an employment pert or shall result in the revocation ofthe permit. Signature Semeo pptan ACERS Date Param AUTHORISATION OF APPLICATION AND DETAILS OF EMPLOYMENT (Tobe complate by employe) 7] "Applaton7Ramheriaton a apices we (ame of empaya) on. AMEN ol physical addres) a Care of |.umwana Mir do hereby SER eres the applicator, by the person whose particlas are provided in Pit, ov an mpleymant pare {2 enable the sald person serv as (ie occupation in Zambia). AU ElecitGan, ceca as 4s ute name of employ AEE Le eae for the period BID en fo. "Delete whicheveris not applicable 2,_| Details of employment offered ‘T/we (name of employer) Avantech Umited oF (postal addres)... Lure ind Kalina prokesion busines) Ooatad Ming e Dason whose parvias are provided i ast, 6) Phas ogempleyment | rhaana Ning Kembla, (8) Job description .. Auto Electncian (© Period ofempluyment otered 27777 Pt iia ‘hat says have you taken to espioy Zaman ilsre i fl tic vacancy ive ale ‘° ‘Thelema soc pee of hs Bauru ads Pas a soos Beng engaged in ate svevan Wish © employ the (0) What wastes othe po akan sr Thsutderehyi oe Sean ood false vask ho hea cought moce (QName of trainee Frank Mukukg oo. (i) Period of trainin June 2018, tonne eat Fi) you donot have a Zarb cizen riod fom the pot fl ate fallow (A) Minimum entry qualification equine fora ont em @) Steps taken to engage Zambian Waince {@) Mthlsappicaion s approved, wil th prspecve employee be inatranea a Waining Pawan disoy so, state how i care ‘ eeeDECLARATION "hereby dedare thatthe foregoing particulars are coret in every deta 7 SeusO Lingy Name of authorised person acting on behalf oj empiover Assistant General Joyment permits whist ouside the country and shall only come when the permit i approved. However, Government employees, volunteers and meccioneran sauy apply for ther permits whist inthe county, @ aFmployment Peritshal ot be valid beyond the dato of expiry ofthe passportol ts holder ir to enter and re-enter Into and to remain within General of Immigration, © Itis an offence to commence employment- @). whthout a valid employment permit; of (2) nde anew employer before charge of employer and/or ecpation cn the Exnployment Pet approved.