JOB APPLICATION FORM
Please complete and return this along with your Resume, Cover Letter
and any other associated documentation to mondelez.internation@oal.com
Which position are you applying for:
POSITION
Please quote the Job Reference Code:
Given name(s) Surname Title (Mr,Mrs,Miss,Ms)
PERSONAL
DETAILS
Street Address
CONTACT
DETAILS
City Town Postcode Country
Home Number Mobile Number Work Number
Preferred Email Address
Name of qualification Year commenced Year completed Name of institution
EDUCATION
& TRAINING
Please attach
all relevant
qualifications
& certificates
to your
application First Aid Certificate: Yes ☐ No ☐ Medication Training: Yes ☐ No ☐
Any other relevant Training:
Previous Employer: Employer 1 Employer 2
PREVIOUS Name of Employer:
EMPLOYMENT
Position held:
Reason for leaving:
Are you a Ghanaian citizen: Yes ☐ No ☐
LANGUAGE &
NATIONALITY If No, visa type:
Details of work conditions:
Issue Date: Expiry Date:
Languages known other than English:
National Police Certificate:
OTHER (Less than six (6) months Yes ☐ No ☐
DETAILS old)
Do you have a current Ghanaian Driver’s License: Yes ☐ No ☐ Manual ☐ Automatic ☐
If no, do you have an International Drivers License: Yes ☐ No ☐ Manual ☐ Automatic ☐
Have you ever been disqualified from driving: Yes ☐ No ☐
If Yes, please provide details:
1st Referee 2nd Referee
Name:
REFEREES
Please provide Position:
two (2) Organization:
employment
referees Contact number:
Email address:
DECLARATIONS
HEALTH
Do you have any previous or current medical condition or restriction, physical or otherwise, which may affect
your ability to perform the essential requirements of the job?
Yes ☐ No ☐
If YES, please provide details:
Important Note: Disclosure of a medical condition or restriction does not necessarily exclude an applicant
from employment.
WORKERS COMPENSATION
This must include any medical condition or restriction arising from a previous workers’ compensation claim.
Failure to provide such information may jeopardize your rights to workers’ compensation if a pre-existing
disability is aggravated at work (Section 79 of the Workers’ Compensation and Injury Management Act 1981).
Yes ☐ No ☐
If YES, please provide details:
CRIMINAL CONVICTIONS
Do you have any current convictions for any offences from any court, or are you currently the subject of any
charge pending before any court?
Yes ☐ No ☐
If YES, please provide details:
DECLARATION BY THE APPLICANT
1. I understand that any misrepresentation of facts in this application could be cause for termination if
employed.
2. I understand that part of the application procedure involves a medical examination by a medical officer
nominated by Senses Ghanaian and I authorize disclosure of the results of this examination to the Senses
Ghanaian.
3. I consent to any reference checks which may be necessary to support this application.
4. I understand Senses Ghanaian reserves the right to verify my passport, visa, driver’s license, demerit
points, Working with Children and Ghana Police Clearance details (this includes access to details of any
spent convictions) and I consent to Senses Ghanaian conducting independent verifications.
I, hereby declare that the information contained in this application is to the best of my knowledge true and
correct.
Signature of Applicant: Date:
Privacy: Your application form contains personal information, which will be dealt with in accordance with our
Privacy Policy. If you are successful in your application your form will become an employment record. If you
are unsuccessful your application form will be destroyed.
Thank you for your application, we appreciate your effort and your interest!
