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									                                               CAYMAN ISLANDS
                                             IMMIGRATION LAW 2003

                                                      SECTION 52

                      Please read the accompanying information leaflet before completing this application.

     The completed application form and prescribed supporting documentation should be sent to: The Chief
      Immigration Officer, Department of Immigration, P.O. Box 1098GT, Grand Cayman, Cayman Islands.

This application is in two parts.
The prospective worker MUST hold a valid passport.
The first part is to be completed by the prospective worker and the second part by the employer.
Each question must be completed or answered even if the answer is negative.
The prescribed application filing fee and all necessary documents must accompany this application.

                                                       PART 1
                                        (To be completed by prospective worker)

1.   Surname (Last Name)
                                                       (Capital Letters)

     Given Names (First Names)

2.   Nationality

3.   Passport number                                             Date of Issue

     Place of Issue                                              Date of Expiry

4.   Date of Birth                                               Country of birth

5.   If you are currently living in the Cayman Islands, your address:

6.   If you are not currently living in the Cayman Islands what is your present address:

7.   Details of any previous visits to the Cayman Islands and periods of residence
8.   Dates and addresses of all places where you have lived for more than 6 months during the past
     10 years if other than stated in reply to question 5 or 6.

     From                              To                                 Address

9.   What is your standard of Education?

10. What professional or technical qualifications do you have?

11. What experience, if any, do you have which is relevant to the job you wish to be employed in?

12. Have you ever previously made an application (whether granted or not) to work in the Cayman Islands?

     If so, please provide details, dates and state whether the applications were granted or refused.

13. If you are of Caymanian descent or have close connections with the Cayman Islands, either historically, or by marriage
     to a Caymanian, please provide details, as this will assist in processing your application
14. Have you ever been convicted of a criminal offence?
    If so, please provide details:

    Nature of Offence               Date                     Place                          Sentence

15. Have you ever been actively involved in politics outside the Cayman Islands?

    If so, please give details including dates of such activities

16. Have you ever had a permit to work refused, revoked or not renewed upon applications in any country
    during the past 15 years?

    If so, when, where and for what reason

17. Do you suffer from any disease or infirmity of mind or body?


        I declare the information contained in this application to be correct to the best of my knowledge and
        belief and am aware that it is a criminal offence to make a statement or representation that is false in
        a material particular which I know to be false or do not believe to be true.

                                     Signature of prospective worker ……………………………………….

                                                                    Date ………………………………………..

Note:   If you have not held a permit or license to work in the Cayman Islands valid within the last 6 months
        you should attach a police clearance certificate from your home country (or last place of residence)
        issued within 6 months of this application (a resident of the United Kingdom may submit a sworn

                            1 FULL FACE                                   1 PROFILE
                           PHOTOGRAPH                                   PHOTOGRAPH
                          with name and date                           with name and date
                            of birth clearly                             of birth clearly
                           printed on back                              printed on back

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