Application Form for Commonwealth Caribbean Seasonal Agricultural Workers Programme (CCSAWP) 20

Please note that the information provided on your Application Form will be treated as private and confidential. You are required to complete ALL sections

SECTION A: PERSONAL INFORMATION

NAME

First Name Middle Name Last Name

Are you known by any other name(s)? Yes No

If “Yes”, please state name(s):

Residential

Address:

If “MAILING ADDRESS” is same as “RESIDENTIAL ADDRESS” kindly write ”Same as above” Mailing

Address

Email

Address

Phone: Mobile No:

Date of

Birth dd /mm / yyyy

Current Age: Birth Certificate PIN No:

Sex: Male Female Height (cm): Weight (kg):

Country of Birth: Nationality:

Driver’s Permit No: Class: Expiry Date:

ID card No.: Expiry Date:

Passport No: Expiry Date:

Marital Status: Single Married Widowed Common Law Separated Divorced Level of Education: Primary Secondary Trade Diploma Tertiary Dependents and ages:

Mother’s Age: Father’s Age: No Dependents

No. of Children: Ages of children:

SECTION B: EMPLOYMENT INFORMATION

Status of Employment: Employed Unemployed P/Time Contract Casual Seasonal Length of time: From: dd /mm / yyyy To: dd /mm / yyyy If currently unemployed,

please state reason for

unemployment:

If currently employed,

please state present

occupation:

Income $0 - $5,000

$5,001 – $10,000

$10,001 - $20,000

Over $20,000

Work Experience:

• Agricultural: 0-1 yr 2-4 yrs 5-10yrs over 10yrs

• Construction: 0-1 yr 2-4 yrs 5-10yrs over 10yrs FORMER EMPLOYERS: List below four (4) employers starting with the last one first Month and Year Name and Address of Employer Reason for Leaving Isaac Osei

Nana sei

ad0d2u@r.postjobfree.com

12/7/1991 31

Ghana

024*******

Ghanaian

050***-***-****

5.3 56.8

244-***-****

G3595579

59

8

64

8

ISA-120*****-***** BE

3

22/3/2023 15/12/2027

Not working

September 2022 Akwabus mining Mining site collapse

- - -

-

-

-

-

-

-

-

29/4/2032 no if

Have you previously worked on the

CCSAWP?

Yes No

If “Yes”, state last year worked:

dd /mm / yyyy

If “Yes”, state reason for being off the Programme: SECTION C: GENERAL INFORMATION

Have you been charged or convicted of a criminal offense, felony or misdemeanor? Yes No Do you have any matters pending in court? Yes No Have you been charged / fined for Driving under the influence? Yes No SECTION D: DECLARATION

I hereby certify that the facts set forth in this Employment Application Form are true and complete to the best of my knowledge. I understand that any misleading, false information or omission provided will result in this application being disqualified for employment consideration.

Applicant’s Name

(BLOCK LETTERS)

Applicant’s Signature

Date

(dd/mm/yyyy)

ISAAC OSEI 22/3/2023

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