EMPLOYMENT APPLICATION FORM

Applicant Information

Name:
Last First Middle

Address:

Email: Telephone:

MM / DD / YEAR
Gender: ☐Male ☐Female Date of Birth:

Position Applied for: Date Available to Start:

Salary Expectation:

Have you ever worked for this company or any of our affiliates?

How did you hear about this job?

Please indicate the name & Department if you were referred by a current itel Employee.

Applicant Information

Marital Status: ☐Single ☐Married Number of Dependents:

Are you a Jamaican Citizen? ☐Yes ☐No Do you have a criminal Record? ☐Yes ☐No

If no, are you authorized to work in Jamaica? If yes, explain:

NIS Number: TRN Number:

ID Type (Passport/National ID/Drivers License) ID Number

Emergency Contact: Name, Relationship, Address, Telephone No.

Education

School Name and Location Period Attended Certificates/Diploma/Degree Received/Major Subjects

College/
University

College/
University

High/
Secondary

Skills and Talents

 References

Please list two professional references

Full Name Relationship:

Company: Phone: (____) ________________

Address:

Full Name Relationship:

Company: Phone: (____) ________________

Address:

Current/Previous Employment

Company: Phone: (____) ________________

Address: Supervisor:

Job Title: Starting Salary $ Ending Salary $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? ☐Yes ☐No

Company: Phone: (____) ________________

Address: Supervisor:

Job Title: Starting Salary $ Ending Salary $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? ☐Yes ☐No

Company: Phone: (____) ________________

Address: Supervisor:

Job Title: Starting Salary $ Ending Salary $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? ☐Yes ☐No

 Vital Information

1. A relative of mine works at itel-BPO Solutions ☐Yes ☐No

2. I have a physical or mental impairment that would prevent me from performing my duties ☐Yes ☐No

3. I am drug free ☐Yes ☐No

4. I object to having a background, reference, drug test or lie detector test that may be required ☐Yes ☐No

5. I object to having a full medical examination to qualify for the position if required ☐Yes ☐No

6. I can work overtime when requested ☐Yes ☐No

7. I can work Saturdays, Sundays and Public Holidays ☐Yes ☐No

8. I can work evening and night shifts when requested ☐Yes ☐No

9. I agree to attend any training sessions/general or department meetings when requested ☐Yes ☐No

10. I agree to work the assigned shift given to me upon successful completion of training ☐Yes ☐No

Health Information

1. Do you have any ongoing medical disorders? ☐Yes ☐No

2. Do you have any allergies or asthma? ☐Yes ☐No

If yes, please indicate

3. Have you consulted, been examined or treated by any physician or practitioner during the past 6 months? ☐Yes ☐No
If yes, please indicate

4. Have you received medical treatment for any disease, condition or disorder? ☐Yes ☐No
If yes, please indicate

5. Are you currently taking any long-term medication? ☐Yes ☐No

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I understand that any information that is
found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my
immediate discharge from the employer’s service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees or agents
to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise
verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer,
its agents, employees or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all
other persons, corporations or organizations for furnishing such information about me. I understand that this application remains current for only 30 days. At the conclusion of
that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. I understand
and agree that if any forgoing information should change after employment, that it is my responsibility and duty to advise Island Outsourcers of such changes immediately.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the forgoing Applicant Statement.

Signature: Date: MM / DD / YEAR