Each application form

Enterprise Achievement Challenge (EACH) A skills transfer programme by the Government of Antigua and Barbuda in collaboration with PDV Caribe (Antigua Barbuda) Ltd

Application Form NOTE TO APPLICANTS: Applicants must answer all questions. A recent photo of the applicant must be attached to this form in the space provided. The applicant must submit a recent Police Record with the application form. The application form must be signed and dated by the applicant. Incomplete application forms will not be considered.

Deadline for submitting applications is 20th November 2013

Place recent photo here

1. Name of Applicant (print in full): ……………………………………………………………………………………………………………………

2. What is your alias or nickname? ……………………………………………………………………………………….…………………………

3. Address (Please Print): …………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………….

4. Date of Birth: D …………… M ………………………... Y ………………………………..

5. Age at last birthday: …………………………

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6. Please circle the area in which you wish to be trained: a) Auto-body Repair; b) Automotive electrical repair; c) Auto-mechanic Repair; d) Basic Carpentry; e) Clothes Making; f) Electrical Wiring; g) Horticultural & Landscaping; h) Joinery; i) Plumbing; j) Refrigeration; k) Sewing Machine Repair; l) Shoe and Apparel Repair; m) Small Engines Repair; n) Upholstery; and o) Welding; 7. What is the highest level of education you have completed? (Please circle the answer) a) Primary b) Secondary c) College d) None of the above 8. Do you have any illness that could impact your participation in this programme? Yes……. No………

If yes, please explain: ………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………

9. Please provide name address and telephone number of someone who can be contacted in case of an emergency: ……………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………

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10. Please List Two References: I.

Mr/Ms/Mrs:(print name) ………………………………………………………………………………………..

Where does this person work? ………………………………………………………………………………………

Contact number: ………………………………………………………….

II. Mr/Ms/Mrs: (print name) ………………………………………………………………………………………………….

Where does this person work? ………………………………………………………………………………………………….

Contact number: …………………………………………………………..

Applicant’s Declaration: I declare that, to the best of my knowledge, all information provided on this application form is accurate.

Signature of applicant: …………………………………………………………………………………………………………………….

Date:……………………………………………………………………

Completed application forms must be enclosed in an envelope marked: EACH Oversight Committee and taken to: The Old Ottos Primary School building on Ottos Hill between 12noon and 3pm from Monday 11th to Friday 15th November 2013 and Monday 18th to Thursday 20th November 2013.

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