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KFC Application Form
Personal Details
Name
*
Email
*
Phone
*
NIS#
*
D.O.B
*
Address
Emergency Contact Information
Name
Relationship
Phone#
Mobile#
Address
Employment Information
Position Desired
Can you perform the essential functions of the position for which you are applying
Select option
Yes
No
If No, please explain
When would you be able to begin work?
Salary expectation?
Eligibility for employment in St. Lucia
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St. Lucia
Resident
OECS
Caricom
Other
Have you ever worked under another name?
Select option
Yes
No
If yes, what was it and what was the reason for the change?
Have you ever been convicted of a felony or misdemeanour in the last seven years?
Select option
Yes
No
Have you ever been accused of being dishonest in any previous employment?
Select option
Yes
No
If Yes, please explain
Have you ever worked for the company before?
Select option
Yes
No
If Yes, where?
Employment History
Name of company
Phone#
Supervisor Name & Title
Address
Dates Employed
From
To
Rate of pay
Starting
Ending
Position held
Reasons for leaving
Duties
Education
School
Name and location of institution
Course of study
Start Date
End Date
Diploma/Degree
College/University
Name and location of institution
Course of study
Start Date
End Date
Diploma/Degree
Vocational
Name and location of institution
Course of study
Start Date
End Date
Diploma/Degree
Graduate Work
Name and location of institution
Course of study
Start Date
End Date
Diploma/Degree
Have you completed any additional special courses, seminars and/or training that would enable you to perform in the position for which you are applying?
Select option
Yes
No
If Yes, please describe?
Do you suffer from any medical condition/allergy which may restrict your ability to perform in this position?
Select option
Yes
No
If Yes, please describe?
Do you have any commitments that would restrict your hours/days of work?
Select option
Yes
No
If Yes, please describe?