APPLICATION FORM Attach a

passport size
photo of
BSP/Colonial Fiji yourself.
Private Mail Bag
SUVA

Position Applied For:

Please answer each question clearly and completely. Type or print legibly. Read carefully
and follow all instructions. You may attach additional pages of the same size should you
need more space. Please attach a recent passport size photograph.
1. Family name (Surname) First name

2. Date of Birth 3. Nationality Fiji citizen: Yes_ No _ (If 4. Gender:

no do you have a work permit?): M_ F_
Yes _ No _.

5. Residential Address:

Telephone no.
6. Postal Address (If different from that indicated in box 6): 7. Work Telephone no. (if any)

Telephone no.
8. Would you accept employment for less 9. Have you previously submitted an application to
than 6 months? BSP/Colonial? If so, when?
10. EDUCATION: Give full details. Please give exact titles of Qualification, names of the educational
institutions you have attended. (Most recent first).
Name of Institution Attended from/To Qualifications obtained
Year

11. List membership of professional societies.

12. EMPLOYMENT RECORDS: Starting with your present position, list in reverse order every Position you
have held. Use a separate block for each Position. If you need more space, attach additional pages of
the same size.
PRESENT POST

(i)Year Salary per Position Title:

From/To annum
Name of Employer Reason for leaving

Address of Employer Brief Description of your duties

(ii)Year Salary per Position Title
From/To annum
Name of Employer Reason for leaving

Address of Employer Brief Description of your duties

(iii)Year Salary per Position Title

From/To annum
Name of Employer Reason for leaving

Address of Employer Brief Description of your duties

13. Referees: List three persons not related to you who are familiar with your character and qualifications
and who may be contacted for a reference.
Full Name Full Address Business or Occupation

14. State any other relevant facts in support of your application.

15. Have you ever been arrested, indicted, or summoned into Court as a defendant in a criminal
proceeding, or convicted, fined, or imprisoned for the violation of any law (excluding minor traffic
violations)? Yes __ No __ If “yes” give full particulars of each case in an attached statement.

16. Have you ever had a Receiving Order made against you, or been a Director or Office Bearer of any
Company which has been placed into Liquidation or Wound Up? If so, please provide particulars:

17. Do you hold any Directorships, Shareholdings in any Company or Board Memberships? If so, please
list:
Name of Company Position Held (Director, Shareholder, Board
Member)

18. Is there any physical or medical condition you would like us to be made aware of? (You do not have to
answer this Question).

19. I hereby expressly consent to BSP/Colonial conducting a background credit check with Data Bureau
and obtaining any relevant information it deems necessary in order to assess my application for
employment with BSP/Colonial.

20. I certify that the statements made by me in answer to the questions above are true, complete and
correct to the best of my knowledge and belief. I understand that any misrepresentations or material
omission made on a BSP/Colonial form or other document renders a staff member of BSP/Colonial liable
to termination or dismissal.

Date: Signature:
Note: You may be requested to provide documentary evidence of the statements you have made above.
Do not, however, send any documentary evidence until you have been asked to do so and, in any event,
do not submit the originals of any references, testimonials or certificates of academic achievement unless
they have been obtained for the sole use of BSP/Colonial.