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The information requested below is essential for us to assist you with your work permits and visas. Due to the nature of immigration requirements, some of the essential information is of a personal nature. All details will remain strictly confidential and will be utilized only to obtain the proper documents for you. To download a MS Word version of this document, right click on this link and select "Save Target As" (for mac users, CTRL + click). Part I: Personal Particulars 1. Full (Legal) Name: _________________________________ 2. Date of Birth (DD/MM/YY): / / (Male/Female - please delete or underline appropriately) 3. Country of Citizenship: _________________ Country of Birth: _________________ Former Nationality: _________________ 4. Passport Expiration Date (DD/MM/YY): / / (List even if expired) 5. Daytime Phone Number: _________________ Evening Phone Number: _________________ Mobile Phone Number: _________________ Fax Number: _________________ E-mail Address: _________________ 6. Company Name: _________________________________________________________________ 7. Company Address: _______________________________________________________________ 8. Home Address: __________________________________________________________________ 9. Date of Hire with Current Employer (DD/MM/YY): / / 10. Current Job Title: __________________________________________________________ 11. Do you possess post-secondary degrees? ___ Bachelors/4 year equivalent ___ Masters/Doctorate Part II: Spouse, children, and other dependents Complete this section only if you have a spouse, children, or other dependents that will be relocating with you. Do not complete this section if you have children that will simply visit you periodically. 1. Accompanying Family Details:
2. If you do not intend for you and your family to relocate at the same time, please explain below: __________________________________________________________________________ __________________________________________________________________________ 3. Will you be traveling with a pet? ___ Yes ___ No Part III: Details of Relocation/Assignment Overseas 1. Information about the place where you will be working: Country: _______________________________ City of Employment: ______________________________ Planned Date of Departure (DD/MM/YY): / / Is this date flexible: ___ Yes ___ No Expected Duration in Country: _________________________________________________________________ (If you are not relocating, please detail the terms of your assignment, i.e., 3 wks in, 1 wk out for 6 months total.) Date(s) of planned Business/Home finding trip(s) (DD/MM/YY): __________________________________ 2. Information about the job that you will be performing: Job Title: __________________________________________________________________ Basic Duties: _______________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Official Name of Employer in Country (destination country): _____________________________ 3. Relationship between Employer in Origin Country and Employer in Destination Country: ___ Subsidiary, Parent, or Division of same company ___ None ___ Other 4. Which entity will pay you? ___ Employer in destination country ___ Employer in origin country 5. Employer Contact Information (to secure company paperwork required for immigration): A. Human Resource or Management Contact in Origin Country: Name: _______________________________ Position: _______________________________ Phone Number: ________________________ Email: _________________________________ Fax Number: _______________________ B. Human Resource or Management Contact in Destination Country: Name: _______________________________ Position: _______________________________ Phone Number: ________________________ Email: _________________________________ Fax Number: _______________________ Part IV: Work Order Signature: ____________________________________ Date (DD/MM/YY): / / |