The New Dim Sum King Restaurant – Employment Application Form
All questions must be completed and in block letters, if any questions is not applicable to you, please
indicate by using N/A
Position Applied For: _________________________________
Personal Information:
Surname First Name Middle Name
Home Address City Postal Code
Mailing Address (if not same as above) City Postal Code
Date of Birth Nationality National ID/DP/Passport
Number
Direct Mobile Home Number Email Address
Emergency Contact:
Full Name (Primary) Relationship Direct Mobile and
home
Full Name (Secondary) Relationship Direct Mobile and
home
Foreign Applicants (additional information required):
Do you have a work permit? [ ] Yes [ ] No
If yes, please provide the permit number, expiry date
Applicants Form of ID/Passport, Permit Copy: [ ] (must be attached to this document)
Health Information:
Do you have any allergies, diseases, or disabilities? [ ] Yes [ ] No
If yes, please specify above.
Do you use alcohol? [ ] Yes [ ] No Do you smoke cigarettes? [ ] Yes [ ] No
Prescribed Medication? [ ] Yes [ ] No
Education Records:
Highest Level of Education Institution Year of Graduation
Are you currently studying, becoming certified or part of a professional development
programme? If yes, please specify above.
Employment Experience:
Employer (1) Job Title Salary
Range
Duration Period Reason for Leaving
Employer (2) Job Title Salary
Range
Duration Period Reason for Leaving
Employer (3) Job Title Salary
Range
Duration Period Reason for Leaving
References (must include a minimum of two persons from previous employment: – direct
supervisor/manager/team lead/business owner) and one character reference.
Reference (1) Company, Position/Role Contact Information
Reference (2) Company, Position/Role Contact Information
Reference (3) Company, Position/Role Contact Information
Additional Information:
Have you ever been convicted of a criminal offense? [ ] Yes [ ] No
If yes, please provide details above.
Do you have a Certificate of Character? [ ] Yes [ ] No
If no, please provide a copy of the receipt as proof of pending certification: [ ] Attached
Are you able to perform the essential functions of the job for which you are applying [ ] Yes [ ] No
If no, describe the functions that cannot be performed above
NIS and BIR Information:
(NIS) Number (BIR) Number
(If not submitted, information will be required upon successful employment)
Consent and Acknowledgment: I hereby consent to the Company performing background,
reference, and criminal checks as part of the employment process. I understand that the
information provided in this application form may be used for these purposes and stored as
required by the Data Protection Act of Trinidad & Tobago.
Signature Date
Notes to Candidate:
The information requested above is for the purpose of aiding the hiring company in
obtaining a background check for the purpose of employment.
This background check may include all or a combination of the following features: a
criminal records search, academic checks, professional license verification, public
government information searches, and past employment checks.
In accordance with the Data Protection Act of Trinidad & Tobago, you are advised that
some or all of the information provided in the Details of Candidate section of this form
may be stored by the Credit Bureau(s) used.
All employers listed in this form will be contacted. If you do not wish for your current
employer to be contacted, do not include any details related to your current employer on
this form.
A copy of National Identification is required to commence the background check. All
copies of identification are safely stored whilst the background check is being performed.
Declaration:
I hereby declare that the information provided in this application form is true and correct to the
best of my knowledge. I understand that any false information or misrepresentation may result in
my disqualification from employment or termination of employment if discovered after hiring.
Signature Date
For Office Use Only:
Interview Date Interviewer
Date Available to Start: ______________________
Notes
