Skilled Worker Visa

Entry Clearance Application Questionnaire

Registration

1. Your email address mlambocourage0@gmail.com

2. Mobile number (with country code) +263772995823

3. Can you be contacted by telephone call and text Yes, I can be contacted by both telephone and
message? If not, please specify your preference. email

4. Certificate of Sponsorship reference number

Personal Information

5. Given name Courage

6. Family name Mlambo

7. In addition to the names already provided, are N/A

you now or have you ever been known by
another name? Please provide your previous
name(s), the date of change and the reason
together with supporting documents.
You must provide all your names. For example,
if you changed your name after marriage or
have a different name that you use for
professional purposes.

8. What is your relationship status? (single, Partners Details:

married/civil partnership, unmarried partner,
Name: Kabwe Gamuchirai Miriam
divorced/civil partnership dissolved, separated,
widowed or a surviving civil partner) Marriage status: Married
Please also provide details of partner (as shown Nationality: Zimbabwean
on passport) Date of Birth: 01 March 1993
Live together?: Yes

9. Date of birth 13 August 1992

10. Home address (including post code) 2452, Dufu Street, Ruwa, Zimbabwe

11. When did you start living at this address 01/08/2018

(DD/MM/YYYY)?

12. What is the ownership status if your home? E.g. Rent

own, rent or other. If other, please provide
details
13. Have you lived anywhere other than your N/A
current address during the past 2 years? If so,
please give details of any previous address, how
long you lived there (i.e. from DD/MM/YYYY to
DD/MM/YYYY).

14. Where were you born? City: Chipinge

Country: Zimbabwe

15. Do you have a valid passport? Passport number: EN160631

Issuing authority: Zimbabwe
Issue date: 27/08/2014
Expiry date: 26/08/2024

16. Is it your first passport? If it’s not, please First Passport

provide the details of your previous passports
with copies.

17. Do you have a valid national identity card? National identity card number: 13-247248 G13
This includes identity cards, issued from non-UK Issuing authority: Zimbabwe
governments. This does not include driving
Issue date: 02/03/2012
licences. If you have an internal passport,
provide the details here. Expiry date: N/A

18. Do you currently hold, or have you ever held, Country of other nationality 1: N/A
any other nationality or citizenship?
Date held from: N/A
You must provide all the nationalities that you
Date held to: N/A
currently hold or have ever held.
Still hold this nationality?

19. If you hold any other nationality or citizenship, Passport number: N/A
do you have any passports for these additional
Issuing authority: N/A
nationalities or citizenships?
Issue date: N/A
Expiry date:

20. If you hold any other nationality or citizenship, National identity card number: N/A
do you have any national identity cards for
Issuing authority: N/A
these additional nationalities or citizenships?
Issue date: N/A
Expiry date:

21. Date you plan to arrive in the UK 01/07/2022

(DD/MM/YYYY)

22. What languages do you speak fluently? ENGLISH AND SHONA

English Language Assessment

23. If you are applying as a doctor, dentist, nurse or Yes/No

midwife, have you passed an English Language
YES
assessment accepted by the relevant regulated
professional body as a requirement for
registration?

24. Have you provided evidence of your English Yes/No

language ability in a previous application?
If Yes, please provide further detail
You must have provided evidence that you
NO
either:
 scored level B1, B2, C1 or C2 on an
approved English language test which
assessed your reading, writing,
speaking and listening skills
 have a degree which was taught in
English
 have an English GCSE, A level or Scottish
National 4 or 5, Higher, or Advanced
Higher qualification

25. Do you have a degree equivalent to a UK Country your degree was taught in: NO
Bachelor's degree which was taught in English?

26. Do you have an academic PhD? NO

This includes any PhD based on study or
research at a university.

27. Is your PhD relevant to your job in the UK? N/A

28. Do you have a National Academic Recognition N/A

Information Centre (NARIC) reference number
for your PhD?
If you do not have a NARIC reference number,
you will need to provide a copy of your full PhD
certificate.

Parents Information

29. Mother’s given name BLESSING

30. Mother’s family name MHLANGA

31. Mother’s date of birth 09 May 1967

32. Mother’s country of nationality ZIMBABWE

33. Has she always had the same nationality? If not, SAME NATIONALITY
please provide her country of nationality when
 she was born

34. Father’s given name BENJAMIN

35. Father’s family name MLAMBO

36. Father’s date of birth 13 December 1965

37. Father’s country of nationality ZIMBABWE

38. Has he always had the same nationality? If not, SAME NATIONALITY
please provide his country of nationality when
he was born

Where you will stay in the UK

39. Do you know where you will be staying in the
UK? If so, please provide full address including
postcode
If so, please provide: N/A
- Full address: N/A
- Is this the home of a family member,
friend or another person you know? Please
state your relationship to that person:
- Name of that person:
- Contact number:

40. Will you be living anywhere else in the UK? If so, please provide:
This includes staying in: - Full address:
 a hotel or bed and breakfast (B&B) - Name of the owner:
 accommodation provided by an employer - Date you arrive:
 a private home with friends or work - Date you leave:
colleagues
 accommodation provided by the
educational institution where you will be
studying
 any other type of accommodation

UK Travel and Medical History

41. Have you been to the UK in the past 10 years? If How many times: N/A
yes, please state how many times.
Trip 1:
If you are unsure of the exact number, provide
- Purpose:
an estimation. You will be asked to provide
- Date arrived:
details for up to 3 of your most recent times in
- Length of stay:
the UK.
Trip 2:
- Purpose:
- Date arrived:
- Length of stay:
Trip 3:
 - Purpose:
- Date arrived:
- Length of stay:

42. Have you ever been given medical treatment in N/A

the UK?
For example, if you visited a doctor, clinic or
hospital, this counts as having medical
treatment

43. Where did you go for your previous medical Treatment 1: N/A
treatment in the UK?
- A&E at a hospital or to a doctor, clinic or
hospital for non-emergency treatment:
- Name of hospital, clinic or doctors’
surgery:
- Full address of the hospital:
- Date received this medical treatment:
- Date finished this medical treatment:

44. Were you told that you had to pay the hospital, N/A
clinic or doctor's surgery for your medical
treatment? If so, have you paid the full
amount?

UK Visa

45. Have you been issued with a UK visa in the past Visa 1: N/A
10 years?
- Date of visa issue:

National insurance number & UK driving licence

46. If you have a UK national insurance number, N/A

please state what it is?

47. If you have a UK driving licence, please state N/A

your licence number?

48. Have you received any public funds (money) in If so, please provide details together with
the UK? documents to show the public funds you or
anyone else who is part of this application
Including: universal credit, income-based
received any time during the 12-month period
jobseeker’s allowance, income-related
prior to the date of this application (e.g. bank
employment and support allowance, income
statements or letters): N/A
support, social fund payment, state pension
credit, working tax credit, child benefit, child tax
credit, attendance allowance, carer’s allowance,
disability living allowance, personal
independence payment, severe disablement
 allowance, council tax benefit, council tax
reduction, housing benefit, housing or
homelessness assistance, or any other types of
public funds or benefits

Travel to Australia, Canada, New Zealand, USA, Switzerland or the EEA

How many times have you visited the following
49. How many times: N/A
places in the past 10 years?
Visit 1: N/A
 Australia
 Canada - Country: N/A
 New Zealand - Purpose of the visit:
 USA - Date of arrival:
 Switzerland - Date of departure: N/A
 European Economic Area* (do not include Visit 2: N/A
travel to the UK)
- Country:
You will be asked to provide details for up to 2 - Purpose of the visit:
of your most recent times in any of the - Date of arrival:
countries listed above. - Date of departure:

World Travel History

50. Have you been to any other countries in the Trip 1: SOUTH AFRICA
past 10 years?
- Country: SOUTH AFRICA
Do not include visits to the UK, USA, Canada, - Purpose of the visit: BUSINESS
Australia, New Zealand, Switzerland or EEA. - Date of arrival: DECEMBER 2019
- Date of departure: JANUARY 2020
You will be asked to provide details for all your
visits to any other countries that NOT listed Trip 2:
above for the past 10 years.
- Country:
- Purpose of the visit:
- Date of arrival:
- Date of departure:

[Please include more trips if necessary]

Immigration History

51. For either the UK or any other country, have If so, please provide details of what happened
you ever been: (including country, date and detail of the
event): NO
 Refused a visa
 Refused entry at the border
 Refused permission to stay or remain
 Refused asylum
 Deported
 Removed
 Required to leave
  Excluded or banned from entry

Person of Good Character

52. Have you ever: NO

 entered the UK illegally
 remained in the UK beyond the validity of
your visa or permission to stay
 breached the conditions of your leave, for
example, worked without permission or
received public funds when you did not
have permission
 given false information when applying for
a visa, leave to enter, or leave to remain
 breached UK immigration law in any other
way
If so, please provide details of what happened
(including date and detail of the event).

53. At any time have you ever had any of the NO

following, in the UK or in another country?
 A criminal conviction
 A penalty for a driving offence, for
example disqualification for speeding or no
motor insurance
 An arrest or charge for which you are
currently on, or awaiting trial
 A caution, warning, reprimand or other
penalty
 A civil court judgment against you, for
example for non payment of debt,
bankruptcy proceedings or anti-social
behaviour
 A civil penalty issued under UK
immigration law
You must tell us about spent as well as
unspent convictions. You must tell us about
any absolute or conditional discharges you
have received for an offence.
If so, please provide details of what happened
(including country, date and detail of the
event).

54. In either peace or war time have you ever been NO

involved in, or suspected of involvement in, war
crimes*, crimes against humanity, or genocide?
If so, please provide detail.
55. Have you ever been involved in, supported or NO
encouraged terrorist activities* in any country?
If so, please provide detail.

56. Have you ever been a member of, or given NO

support to, an organisation* which has been
concerned in terrorism? If so, please provide
detail.

57. Have you, by any means or medium, expressed NO

views that justify or glorify terrorist violence or
that may encourage others to commit terrorist
or other serious criminal acts? If so, please
provide detail.

58. Have you ever been a member of, or given NO

support to, an organisation* which is or has
been concerned with extremism? If so, please
provide detail.

59. Have you, by any means or medium, expressed NO

any extremist views*? If so, please provide
detail.

60. Have you, as a part of your employment or NO

otherwise, undertaken paid or unpaid activity
on behalf of a non-UK government which you
know to be dangerous to the interests or
national security of the UK or its allies? If so,
please provide detail.

61. Have you ever engaged in any other activities NO

which might indicate that you may not be
considered to be a person of good character? If
so, please provide detail.

62. Is there any other information about your I AM A HARD WORKING AND PROACTIVE
character or behaviour which you would like to MIDDLE AGED MAN
make us aware of? If so, please provide detail.

Your Employment History

63. Have you ever worked for any of the following If so, please provide: N/A
types of organisation? Include information for
- Job title: N/A
any paid or unpaid work. Select all that apply.
- Rank: N/A
 Armed Forces (career) - Organisation: N/A
 Armed Forces (compulsory national or - Dates of employment:
military service)
 Government (including Public or Civil
Administration and non-military
compulsory national service)
  Intelligence services
 Security organisations (including police
and private security services)
 Media organisations
 Judiciary (including work as a judge or
magistrate)

Sponsor licence number

64. What is your sponsor licence number as shown

on your Certificate of Sponsorship?

65. Has your sponsor agreed to certify your

maintenance on your certificate of
sponsorship? This should state on your
Certificate of Sponsorship.

66. What is the title of the job you are coming to

the UK to do?

67. How much will you be paid in GBP per year to

do this job?

68. If required, have you obtained an overseas

criminal record check?

69. Has your sponsor or employer confirmed you

are eligible for the Health and Care visa?

70. Are you applying as a midwife or nurse?

71. Is your job on the current shortage occupation

list?

72. What is the length of your Certificate of - 3 years or less

Sponsorship (CoS)? - More than 3 years

73. If you needed to add more information about

your application but were not able to, you can
write it here.

*European Economic Area (EEA) Countries

**Definitions
War crimes
War Crimes are grave breaches of the Geneva Conventions committed during an armed conflict. This
includes an internal armed conflict and an international armed conflict.

The types of acts that may constitute a war crime include:

 wilful killing
 torture
 extensive destruction of property not justified by military necessity
 unlawful deportation
 the intentional targeting of civilians
 the taking of hostages

Crimes against humanity include:

 Acts committed at any time (not just during armed conflict) as part of a widespread or systematic
attack, directed against any civilian population with knowledge of the attack. This would include
offences such as murder, torture, rape, severe deprivation of liberty in violation of fundamental
rules of international law and enforced disappearance of persons

Genocide includes:

 Acts committed with intent to destroy, in whole or in part, a national, ethnic, racial or religious
group

This guidance is not exhaustive. The full definitions of war crimes, crimes against humanity and genocide
can be found in Schedule 8 of the International Criminal Court Act 2001 at legislation.gov.uk. It is your
responsibility to satisfy yourself that you are familiar with the definitions and can answer the questions
accurately.

Terrorist activities
Terrorist activities are any act committed, or the threat of action designed to influence a government or
intimidate the public and made for the purposes of advancing a political, religious or ideological cause and
that:

 involves serious violence against a person

  may endanger another person’s life
 creates a serious risk to the health or safety of the public
 involves serious damage to property
 is designed to seriously disrupt or interfere with an electronic system

Terrorist organisations
An organisation is concerned with terrorism if it:

 commits or participates in acts of terrorism

 prepares for terrorism
 promotes or encourages terrorism (including the unlawful glorification of terrorism)
 or is otherwise concerned in terrorism

Extremist organisations
An organisation is concerned with extremism if for example it:

 is concerned in vocal or active opposition to fundamental British values, including democracy, the
rule of the law, individual liberty, mutual respect and tolerance of different faiths and beliefs
 calls for the killings of members of our armed forces, whether in this country or overseas

Extremist views
Have you, by any means or medium, expressed views that:

 oppose fundamental British values, including democracy, the rule of the law, individual liberty,
mutual respect and tolerance of different faiths and beliefs
 call for the killing of members of our armed forces, whether in this country or overseas