Application Form for Mauritians Seeking Employment Abroad

FORM 1

(FOR OFFICE USE ONLY) CODE:*EIC/IOM/Call Centre(*Select as appropriate)______DATE RECEIVED______

1.  Personal Information

Family Name (Block Letters):

First Names (Block Letters):

Address (Block Letters):

(Locality & District)

Telephone: Contact no. 1 __ Contact no. 2 ______

E-mail:

National Identity Number:

Passport Number: ______Date of Expiry:

2.  Background Information

Sex: Male |__| Female |__| Date of Birth: |___|___|______| Age: ______

Weight: kg Height: cm

Civil Status: Married |__| Single |__| Separated / Divorced |__|

Widowed |__| Cohabitation/Common Law |__|

Number of Children ______

Do you wear glasses / contact lenses? Yes |__| No |__|

Do you have a Driver’s Licence? Yes |__| No |__| If yes, for which type(s) of vehicle(s) ______

Are you registered with the Ministry of Labour, Industrial Relations & Employment? Yes |__| No |__|

Are you registered with the National Empowerment Foundation? Yes |__| No |__|

Education

3.1 CPE: Pass |__| Fail |__|

GCE O Level - Number of subjects passed ______

SC: Pass |__| Fail |__|

HSC: Pass |__| Fail |__|

GCE A Level - Number of subjects passed ______

3.2 University / Vocational Training

Name of Institution / Name of Course / Certificate/Diploma/Degree / Months/Years of Study

Other Education / Training ______

______

3.3 Have you benefitted from any of the following programmes of the National Empowerment Foundation (NEF)? (You can mark more than one box)

Training under the Placement for Training Programme |__|

Training/Internship under the Special Programme for Unemployed Women |__|

In-company Work Placement |__|

3.4 LANGUAGES (Mark boxes as appropriate)

Languages / Understand / Speak / Read / Write
1 / 2 / 3 / 4 / 1 / 2 / 3 / 4 / 1 / 2 / 3 / 4 / 1 / 2 / 3 / 4
English
French

1. Excellent 2. Good 3. Fair 4. Little

Other Language ______

4. Employment Status

4.1 Employed |__| Unemployed |__| Self Employed |__|

4.1.1 If Unemployed, please state status: School Leaver |__| Student|__| Laid off |__| Laid off under Workfare Programme |__| Work Placement |__| Other:______

4.2 Employment Record (List all Work Experience – Especially Related to Desired Employment):

Job Title (Occupation)
& Salary / Full Time/
Part Time / Description of Work
(All types of work done and specify if work involves physical labour) / Name of Employer
(In Block Letters) / Employment Duration
From
mm/yy / To
mm/yy
Present Employment
1) / F/T / Present
P/T
2) / F/T / Present
P/T
Previous Employment
1) / F/T
P/T
2) / F/T
P/T
3) / F/T
P/T
4) / F/T
P/T
5) / F/T
P/T

List any additional skills: ______

5. Preferences (Please put an ‘X’ in all categories that apply – you can mark more than one box)

5.1 I am interested in: Temporary Work less than 1 year |__|

Temporary Work between 1-2 years |__|

Seasonal Work |__|

5.2 I am interested in:

Agriculture/Fishing/Forestry |__| Food Processing |__| Meat Processing |__| Domestic Services/Caregiver |__| Storekeeper/Stockperson |__| Retailer/Cashier |__|

Electrical/ Mechanical Work |__| Cleaner/Janitor/Concierge |__| Textile/Garment |__| Other Manufacturing Sector |__| Construction/Building Maintenance |__|

Hotel/Restaurant/Food Service |__|Other (please list):

5.3 I would consider working in:

Quebec (Canada) |__| Canada |__| France |__| Australia |__| Other (please list):

6. Additional Information

Have you ever been arrested, fined, or convicted of an offence (e.g. assault, domestic violence, failure to comply with protection order, larceny, embezzlement, falsification of documents, indecent act, petty theft, illegal littering, etc)? Yes |__| No |__|

If yes, please give details:

Have you ever lived IRREGULARLY in another country? Yes |__| No|__|

If yes, please give details:

Have you ever been refused a visa to another country? Yes |__| No |__|

If yes, please give details:

Have you ever had any serious or recurring injuries/illness? Yes |__| No |__|

If yes, please give details:

Have you ever applied for a Certificate of Morality and not obtained it? Yes |__| No |__|

If you hold a Certificate of Morality, what is the date of issue? ______

During the past five years have you lived abroad for more than six months? Yes |__| No |__|

If yes, in which country ______

7. I, , the undersigned, hereby declare that the information provided in this application form is true and accurate to the best of my knowledge. I authorize the International Organization for Migration (IOM), the Government of Mauritius, the National Empowerment Foundation and any party entitled to access the data to share the information included in this application with potential foreign employers at their discretion.

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