EMPLOYMENT APPLICATION

(CAL’S POLICIES PROHIBIT DISCRIMINATION BECAUSE OF AGE, RACE, CREED, COLOUR OR NATIONAL ORIGIN)

LAST NAME FIRST NAME MIDDLE OR MAIDEN NAME

PERMANENT ADDRESS:
HEIGHT: WEIGHT: GENDER: MALE  FEMALE  DATE OF BIRTH (DAY/MONTH/YEAR)

TELEPHONE CONTACT : LANDLINE/HOME PHONE CELLULAR PHONE

EMAIL ADDRESS:
_______________________________________________________________________________________________________
MARITAL STATUS: SINGLE  ENGAGED  MARRIED  WIDOWED  SEPARATED  DIVORCED  COMMON-LAW 
____________________________________________________________________________________________________________
NUMBER OF DEPENDENT CHILDREN: ARE YOU A CITIZEN OF JAMAICA? YES  NO 
____________________________________________________________________________________________________________
HAVE YOU EVER BEEN ARRESTED, SUMMONED OR ARRAINED IN A COURT OTHER THAN FOR TRAFFIC MISDEMEANOR?
YES  NO  EXPLAIN
____________________________________________________________________________________________________________
DO YOU HAVE A VALID DRIVER’S LICENCE? YES  NO  DRIVER’S LICENCE #
____________________________________________________________________________________________________________
WHAT KIND OF WORK DO YOU PREFER? FRIST CHOICE: SECOND CHOICE:

MINIMUM SALARY REQUIREMENT: DATE AVAILABLE TO BEGIN EMPLOYMENT:

____________________________________________________________________________________________________________
CAN AND WILL YOU WORK ON A ROTATING SHIFT SCHEDULE? YES  NO 
CAN AND WILL YOU WORK OVERTIME WHEN NEEDED YES  NO 
_______________________________________________________________________________________________________________________________________
EDUCATIONAL DATA
NAME OF SCHOOL NAMES YEARS GRADUATED DATE OF CXC/DEGREE/CERTIFICATION
& ADDRESS ATTENDED YES/NO GRADUATION
_______________________________________________________________________________________________________________________________________
OTHER TRAINING/
EDUCATION
_______________________________________________________________________________________________________________________________________
COLLEGE/UNIVERSITY
_______________________________________________________________________________________________________________________________________
HIGH SCHOOL
INTERVIEWER’S NOTE:
PREVIOUS EMPLOYMENT: LIST MOST RECENT JOB, INCLUDE ALL JOBS SINCE GRADUATION FROM HIGH SCHOOL (OR YOUR LAST FOUR JOBS
WHICHEVER IS LESS). IF YOU HAD TWO OR MORE DISTINCTLY DIFFERENT POSITIONS WITH THE SAME EMPLOYER, LIST THE POSITIONS
SEPARATELY
_______________________________________________________________________________________________________________________________________
DATES (FROM - TO) NAME & ADDRESS OF PAST EMPLOYERS POSITION SUPERVISOR’S NAME SALARY BASE REASON FOR LEAVING

_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

INTERVIEWER’S NOTE:
PHYSICAL/HEALTH DATA: HAVE YOU HAD ANY OF THE FOLLOWING HEALTH CONDITIONS?  for YES & X for NO
pg. 1 Revised October 30, 2018 Human Resources Department
TUBERCULOSIS  EPILEPSY  HERNIA  DIABETES  BACK ILLNESS  HEART CONDITION  HIGH BLOOD PRESSURE 

ULCERS  ASTHMA  DEFECTIVE SIGHT/HEARING  ANY PHYSICAL OR MENTAL HEALTH ISSUES  ARE YOU PREGNANT?
YES  NO 

IF THE ANSWER IS YES TO ANY OF THE ABOVE, PLEASE EXPLAIN BRIEFLY:

ANY OTHER ILLNESSES FROM THOSE MENTIONED ABOVE?

HOW MUCH TIME HAVE YOU LOST FROM WORK OR SCHOOL DUE TO ILLNESS IN THE PAST TWO (2) YEARS?

HAS ANY INSURANCE COMPANY REJECTED YOUR APPLICATION FOR LIFE INSURANCE? YES  NO  IF YES, EXPLAIN
MILITARY/ARMY DATA: PRESENT DRAFT STATUS PERIOD OF ACTIVE DUTY (MONTH/YEAR)
TYPE OF DISCHARGE:
BRANCH OF SERVICE: HIGHEST RATING/RANK: CITATIONS/MEDALS RECEIVED:
TYPE OF DUTY: SERVICE SCHOOL:
PRESENT RESERVE STATUS: PRESENT RESERVE BRANCH: PRESENT RESERVE RATING/RANK:

SUPPLEMENTARY DATA:
HAVE YOU EVER APPLIED TO CAL’S BEFORE? YES  NO  DATE
HAVE YOU EVER BEEN TESTED AT CAL’S? YES  NO  DATE
HAVE YOU EVER WORKED AT CAL’S YES  NO  DATE
WHAT WAS YOUR POSITION? WHO WAS YOUR SUPERVISOR?
DO YOU HAVE ANY RELATIVES EMPLOYED AT CALS? YES  NO  IF YES, GIVE NAME/S
RELATIONSHIP TO YOU
DO YOU HAVE FRIENDS EMPLOYED AT CAL’S YES  NO  IF YES, GIVE NAME/S
PRINCIPAL HOBBIES AND ACTIVITIES:
IN CASE OF EMERGENCY, WHOM CAN WE CONTACT FOR YOU:
NAME/S_____________________________________________________________________________________________________

ADDRESS____________________________________________________________________________________________________

TELEPHONE CONTACT/S________________________________________________________________________________________

RELATIONSHIP TO YOU________________________________________________________________________________________

I CERTIFY THAT THE ANSWERS PROVIDED ABOVE ARE ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I AM AWARE THAT
FAILURE TO HONESTLY COMPLETE THIS APPLICATION, INTENTIONAL OMISSIONS OR MIS-STATEMENTS MAY RESULT IN REFUSAL OF
EMPLOYMENT OR DISCHARGE
SIGNATURE OF APPLICANT: DATE COMPLETED:

FOR OFFICE USE ONLY: NIS# TRN# FHP # FHP EXPIRY DATE

NATIONAL ID/PASSPORT/DRIVER’S LICENCE# & EXPIRY DATE:

pg. 2 Revised October 30, 2018 Human Resources Department