| APPLICATION FORM ____________________ There is a notion that one should read everything, including the small-print before signing anything. Please read carefully. Enjoy, or be very alarmed! APPLICATION FORM Notes for your guidance: All questions are mandatory, IN OTHER WORDS, THEY MUST ALL BE ANSWERED, IN FULL. Failure to complete any one part of this Application Form in full, may result in one or more of the following: Failure to instigate any employment Failure to redress any complaint. Failure to accept positive comments. Failure to consider this application at all. Subsequent and in view of this, penalties may be incurred, as thus: a fine equivalent to ONE YEAR'S SALARY OR WAGES may be made. a term of imprisonment not less than ONE YEAR of your life (any benefits, monetary or otherwise, may be with-held). Death by any form/forms as required by any laws persuant at which you reside at the time of your signing of this application form. (The discretion of the persons authorising this Application Form is sacrosanct and final. No further correspondence will be entered into.) Notes on filling out this form, (to assist you better): Please circle all entries where required (penalties may apply if not properly circled, ticked or otherwise completed). Please give full details, where and when they are required. If unsure, or have no knowledge, or claim to have no knowledge, or cannot remember, please indicate why on a seperate sheet including, on the sheet, the appropriate number relevant to the question/answer. These should be signed and dated. Additional note: Answers such as 'unsure', or 'I don't recall' are NOT permissable under the terms of this Application. They will therefore encounter more severe penalties. Please indicate the precise nature of your application (A1): A1- I am applying for______________________________________ (Further pages may be appended, marked A2, A3, A4 etc. All pages must be signed and dated.) APPLICATION FORM Country of Origin______________________ Country of Residence_______________________ Country of Alleigence______________________(If none, please state reason (on a seperate sheet signed and dated) (PLEASE enter all relevant details or CIRCLE/tick (where appropriate) ALL RELEVANT ENTRIES) B-APPLICANT'S Personal Particulars SURNAME________________ FIRST NAME_____________ SECOND NAME_____________ ANY OTHER NAMES, ALIASES, NICKNAMES________________________________________ IF A MARRIED WOMAN, PLEASE STATE YOUR UNMARRIED SURNAME_____________________ AGE ( AS OF THIS APPLICATION) Years__Months__Days__ PLACE OF BIRTH (Preciselocality)______________________ TIME OF BIRTH (Hrs/Minutes/Seconds)_______________ (If not known, please state why on a seperate sheet, signed and dated) NATURE OF BIRTH Normal Caesarian Forceps Other (please specify on a seperate sheet, signed and dated)) STATUS Single Married Seperated Divorced Partner SEX Male Female Other (Please attach chromosomal Certificate (suitably notorised) SEXUAL PROCLAVITIES: Heterosexual Homosexual Bisexual Transexual Paedophile Other (Please specify on a separate sheet, signed and dated) SKIN COLOUR White Brown (Black) Ochre Other (please specifiy)__________________ EYE COLOUR Blue Brown Green Other (please specify)_____________________ DISTINGUISHING MARKS Birthmarks (please state type and location on body (please include photograph)) Piercings (please state nature of piercing, the location/s in the body (please include photograph)) Tattoos (please state exact nature of the tattoo/es, and its/their precise location/s on the body (please include photograph)) Disfigurements (please attach seperate sheet, signed and dated and please include photograph) Religion Protestant Catholic Baptist Jehova's Witness Muslim Other (please specify on a seperate sheet, signed and dated) SENSES HEARING Please attach a recent copy of your hearing assessment. (Form HA1) SIGHT Please attach a copy of a recent sight test. (Form ST1) SMELL Please attach a recent profile of your ability to smell. (Form SM1) TASTING Please attach a recent profile of your ability to taste. (Form T1) or adapt to tastes (Form T1a) TOUCH Please attach a recent profile of your abilty to adapt to touch. (Form TO1) or to adapt to touch (Form TO2) B(a)- ARE YOU AN ADOPTED CHILD? Yes No Don't know If 'yes' give full details of your adoption (including papers relevant to that adoption) If 'no' then go to B(c)-ADDRESS/S If 'don't know' then please explain, in full (please use seperate sheet signed and dated). B(b)- ARE YOU AN ORPHAN? Yes No If 'yes' please give details of your orphan status, including full details of your carer/s (on a seperate sheet, signed and dated). If 'no' then go to B(c)-ADDRESS/S B(c)-ADDRESS/S PERMANENT ADDRESS: Street Number Street City/Town Country Post/Zip Code Length of occupation (days) If this is your permanent address, please answer (in full) these questions: Do you live with a parent/s? Yes No If 'yes' then go to E-Family Particulars If 'no' then give full particulars of those with whom you reside. (please attach a seperate record of each or those persons with which you reside on a seperate sheet, signed and dated). Do you live with relatives? Yes No If 'yes' then give full particulars of those with whom you reside. (please attach a seperate record of each or those persons with which you reside on a seperate sheet, signed and dated). If 'no' then go to next question. Do you live on your own? Yes No If 'yes' please state why (use a seperate sheet, signed and dated) If 'no' please state with whom you live, giving name/s of those with whom you stay and why. Are you a squatter? Yes No If 'yes' please include any material that permits you to squat. (Penalties are incurred if you do not have the right to squat) If 'no', answer the following question: Are you a gipsy? Yes No If 'yes' then please indicate the nearest place we can contact you within the next 24 hours. If 'no' then please continue. OTHER ADDRESSES On a seperate sheet (signed and dated) please list ALL your residential addresses since birth. E- FAMILY PARTICULARS Mother First name Other names, aliases, nicknames (please state) Nee name Married name Date of birth (please attach certificate or certified fascimile) Present address Present telephone number/s (including mobile) Present e-mail address Present Fax number Present Internet URL Nationality Place of birth, including time and location (full address) Place of death (if relevant) including time and location, full address and full details of nature of burial. Father First name Other names, aliases, nicknames (please state) Date of birth (please attach certificate or certified fascimile) Place of birth, including time and location (full address) Present address Present telephone number/s (including mobile) Present e-mail address Present Fax number Present Internet URL Place of death (if relevant) including time and location, full address and full details of nature of burial. IMPORTANT Please attach relevant details (in accordance with the above) of all your relatives up to and including your grandfather and grandmother on seperate sheets (signed and dated). F- EMPLOYMENT HISTORY As of the date of this Application are you: Employed Self-employed Awaiting employment Unemployed Working Part-time Working as a volunteer Too young to be employed On a seperate sheet (signed and dated) please list all your employment history (paid or unpaid) from the earliest age. Please use the format below (which may be copied and pasted to each page). Exact dates (dd/mm/yyyy) Starting Leaving Company/Individual Reason for employment Reason for leaving G- EDUCATIONAL HISTORY As of the date of this Application, please state (on a seperate sheet signed and dated) Every school you have attended, including Pre-Primary (Kindergarten) Primary Secondary Senior Tertiary College/TAFE University Other Please use the format below (which may be copied and pasted to each page). Exact dates, location (address), subjects studied, Grade for each subject. Certificate, Degree, other (specify) H- MEDICAL HISTORY As of the date of this Application, please state (on a seperate sheet dated and signed): It is essential that you reveal all details of your health. To help you we have compiled a list of requirements. Please append all relevant materials. Please use the format below (which may be copied and pasted to each page). List all pre-birth/birth/post birth defects (e.g. variations from the norm, haematomas, genetic defects bone breakages, severe traumas, nightmares, daymares, anxieties, panic syndrome attacks etc.) List all doctors, paediatricans, obstetricians, gynaecologists, mental health consultants, psychologists, psychiatrists (consulted from birth either by others or yourself), hearing/sight/taste/touch specialists, chiropractors, physiotherapists, sports injury therapists, dentists, opticians, hearingspecialists and include details of spectacle makes, hearing-aid makers, prosthetic makers and so forth. List all hospitals, clinics, medical centres. Have you ever recieved Emergency treatment? Yes No If 'yes', please state: When Where Why on a seperate sheet dated and signed). If 'no', then please continue. To serve you better, please append these documents: A recent eye test A recent audio/hearing test A recent taste test A recent touch test All x-rays taken for the purposes of: tests for lung cancer tests for cancer (e.g. mammogram) tests for spinal problems other (please state) A recent chromosomal test A recent retinal pattern A recent blood pressure test A recent urine test result A recent blood test A recent cholesterol test A recent finger-print sample Other Please attach also any cat-scans and state the purpose or reason for this/them Please attach also any readings from: Palmistry Phrenology Tarot I-Ching Runes Aromatherapy Reflexology Playing Cards Oija boards Other (please state) I- HOBBIES AND INTERESTS Please state (on a seperate sheet dated and signed): All your hobbies and intersts. These must be as detailed as possible. They should include: Reading (e.g. Fiction, non-fiction, biographis, auto-bigraphies, poetry, short srories, novels etc.) Writing (e.g. Fiction, non-fiction, biographis, auto-bigraphies, poetry, short srories, novels etc.) Drawing/painting (e.g. oils, acrylics, crayons, pencil, pen-and-ink, CAD, etc.) Sports: Active Passive (state specific sports/sports) Films/videos/DVD (state preferences, e.g. Adventure, drama) Computers: Software/Hardware/Games (state type of games you like to play) Watching T.V. (state types of programmes you like to watch) Listening to radio (state types of programmes you like to listen to) Hi-Fi (state types of musicyou like to listen to) Fetishes (please state which and your involvement) Other. Please be specific (penalties apply). J- RELIGIOUS PROCLIVITIES Please state you religion, e.g. Christian Jew Methodist Conformist Non-conformist Muslim Presbyterian Catholic Atheist Taoist Hindu Maoist None Other (please state) Have you been: Baptised Christend Other (including none) If Christened please append certificate (or Certified facsimilie) If Baptised please append Certificate (or Certified facsimilie) If other (or Certified facsimilie) or explain in detail (on a seperate page signed and dated) Are you a circumcised male of female? Yes No Please attach evidence (e.g. photo, doctor's certificate, tribal evidence) K- POLITICAL PROCLIVITIES Are you politically active? Yes No If 'no' then please expalin why , in detail and on a seperate sheet signed and dated). If 'yes' then please answer the following questions: Which political party do you align with? (Your country of residence) In terms of political jargon, are you: Right Right of Right Center of Right Left of Right Center Right of Center Center Center Left of Center Left Right of Left Center of Left Left of Center A democracy is, according to Abraham Lincoln, Government Of the People, By the People and For the People. Do you believe this statement to be correct? Yess No If 'yes' do you agree to the dictates of this form of government/management? Yes No If 'no', please explain why (on a separate sheet siogned and dated). If 'yes' , please explain why (on a seperate sheet signed and dated). L- LANGUAGE PROCLIVITIES Please state your native tongue__________________________ Please state your preferred language______________________ At what level do you speak other tongues? None Beginner Fluent Expert (Please state how and wneh you began to speak another language. e.g. you wanted to leanr it, you were forded to learn it) M- DRUGS Note: A drug is something that we ingest (drink, eat, smell, taste, hear), and upon which we may rely mentally or physically to lead our lives. All things in the universe are drugs when we ________________________________________________________ NOTE: Please do not answer any of the above questions. |
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