DR 6/2 E - Application for Employment I1

LABEL HOUSE GROUP LIMITED APPLICATION FOR EMPLOYMENT FORM PERSONAL INFORMATION (CONFIDENTIAL) SURNAME: ADDRESS:

FIRST NAME:

TELEPHONE: DATE OF BIRTH: Day / Month / Year Home- ______/______/______Cell- ______

PLACE OF BIRTH: NATIONALITY MARITAL Single Married Separated Divorced Common Law SEX: NO OF STATUS: Male CHILDREN: Female

ID CARD NO: NATIONAL INS NO: ARE YOU A HOLDER OF A VALID DRIVER’S PERMIT Yes No

DESIRED EMPLOYMENT POSITION APPLIED FOR: DATE YOU CAN START: Day / Month /Year ______/______/______COMPENSATION DESIRED: APPLIED TO US BEFORE: Yes No WHO REFERRED YOU TO THIS COMPANY: Employment Agency Newspaper Friend Walk In Other (Please specify) ______

EDUCATIONAL BACKGROUND SCHOOL LEVEL FROM TO NAME & LOCATION EXAMINATION/ OF INSTITUTION QUALIFICATION

PRIMARY SCHOOL

SECONDARY SCHOOL

TECHNICAL UNIVERSITY

EMPLOYMENT HISTORY ((Please start with the most recent employer first) FROM TO NAME & ADDRESS OF POSITION DESCRIPTION OF SALARY REASON FOR EMPLOYER HELD WORK LEAVING

PLEASE LIST ANY PROFESSIONAL SOCIETIES OR ORGANIZATIONS OF WHICH YOU ARE A MEMBER:

LABEL HOUSE GROUP LIMITED 24-25 FREDERICK SETTLEMENT INDUSTRIAL ESTATE, CARONI, TRINIDAD, W.I. August 2012 PAGE 1 OF 3 DOC REC 6/2 E LABEL HOUSE GROUP LIMITED APPLICATION FOR EMPLOYMENT FORM GENERAL -

SPECIAL TRAINING/ DESCRIBE BRIEFLY ANY ADDITIONAL SKILLS, KNOWLEDGE OR EXPERIENCE YOU HAVE WHICH YOU BELIEVE SKILLS: MAY BE AN ASSET TO THIS COMPANY

REFERENCES (Please state at least 3 references, with at least 2 being work related references. No Relatives) NAME & ADDRESS OF REFERENCE COMPANY OCCUPATION TELEPHONE CONTACT

GENERAL DO YOU CONSIDER YOURSELF A TEAM PLAYER? YES NO ARE THERE ANY ILLNESSES THAT WILL PREVENT YOU FROM PERFORMING YOUR DUTIES? YES NO IF YES PLEASE EXPLAIN BRIEFLY:

DO YOU HAVE ANY HEALTH PROBLEMS/ PHYSICAL DISABILITY WHICH MAY AFFECT YES NO YOUR ABILITY TO PERFORM THE JOB? ARE YOU WILLING TO WORK ON A SHIFT BASIS? YES NO WOULD YOU BE WILLING TO WORK FROM MONDAY THROUGH SUNDAY? YES NO HAVE YOU USED NARCOTIC DRUGS AT ANY TIME? YES NO IF EMPLOYED WILL YOU ACCEPT TO BE TESTED AT ANY TIME FOR DRUGS? YES NO HAVE YOU EVER BEEN CONVICTED OF A CRIME? YES NO ARE YOU RELATED TO ANY EMPLOYEE? YES NO IF YES PLEASE STATE; NAME, DEPT. AND RELATIONSHIP:

AUTHORIZATION

“I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I HEREBY AUTHORISE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN. I ALSO GIVE MY CONSENT FOR THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY OTHER PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE. I RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY ARISE FROM SUCH RESPONSES TO REFERENCE REQUESTS.”

______SIGNATURE DATE

FOR OFFICIAL USE ONLY DO NOT WRITE IN THIS AREA

LABEL HOUSE GROUP LIMITED 24-25 FREDERICK SETTLEMENT INDUSTRIAL ESTATE, CARONI, TRINIDAD, W.I. August 2012 PAGE 2 OF 3 DOC REC 6/2 E LABEL HOUSE GROUP LIMITED APPLICATION FOR EMPLOYMENT FORM INTERVIEWER’S COMMENTS DATE: Day / Month /Year INTERVIEWED BY: ___/______/_____ POSITION:

SIGNATURE: ______DATE: ______

LABEL HOUSE GROUP LIMITED 24-25 FREDERICK SETTLEMENT INDUSTRIAL ESTATE, CARONI, TRINIDAD, W.I. August 2012 PAGE 3 OF 3 DOC REC 6/2 E