2012 APPLICATION FORM - Antigua and Barbuda
2012 APPLICATION FORM - Antigua and Barbuda 2012 APPLICATION FORM - Antigua and Barbuda
5. Telephone number(s) ____________________________/________________________________ Home Mobile 6. E-mail Address __________________________________________________________________ B. Applicant’s Qualifications: 13. Secondary/High School Exam Board /Subject /Grade /Year Educational Institution _________________________________________________ ____________________ _________________________________________________ ____________________ _________________________________________________ ____________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ 14. Higher Educational Institution Certificate /Diploma /Degree /Year __________________________ _________________________________________________ __________________________ _________________________________________________ __________________________ _________________________________________________ 15. Other __________________________ __________________________ __________________________ __________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ 16. Name of preferred Ministry/Ministries for attachment (2 maximum) _______________________________________________________________________________ _______________________________________________________________________________ 17. Department/s of this Ministry/these Ministries preferred (2 maximum) _______________________________________________________________________________ DECLARATION BY APPLICANT I declare that the statements contained in this application are, to the best of my knowledge, true and accurate. I authorize the administrators of the LEAP to seek verification of the information provided for the purposes of determining whether to approve this application Date completed _______________________ DD/MM/YYYY 2
If your application is approved, you will be asked to submit the following documents to the Ministry of Finance: DOCUMENTS: i. Recent Passport-sized photo ii. Certified copy of photo page and date of expiration page of Passport iii. Certified copy of your birth certificate iv. A certified copy of your academic certificate/diploma/ degree Please e-mail the completed form to one of the following addresses: raecollis@gmail.com or gimhoffgordon@gmail.com ** Deadline for submitting this application form is Sep 29, 2012 This Space for Official Use Only Authorized Signatures: Coordinator: ____________________________________ Date:_____________________ DD/MM/YYYY Permanent Secretary: ____________________________ Date:_____________________ DD/MM/YYYY 3
5. Telephone number(s) ____________________________/________________________________<br />
Home<br />
Mobile<br />
6. E-mail Address __________________________________________________________________<br />
B. Applicant’s Qualifications:<br />
13. Secondary/High School Exam Board /Subject /Grade /Year<br />
Educational Institution<br />
_________________________________________________<br />
____________________<br />
_________________________________________________<br />
____________________<br />
_________________________________________________<br />
____________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
14. Higher Educational Institution Certificate /Diploma /Degree /Year<br />
__________________________ _________________________________________________<br />
__________________________ _________________________________________________<br />
__________________________ _________________________________________________<br />
15. Other<br />
__________________________<br />
__________________________<br />
__________________________<br />
__________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
_________________________________________________<br />
16. Name of preferred Ministry/Ministries for attachment (2 maximum)<br />
_______________________________________________________________________________<br />
_______________________________________________________________________________<br />
17. Department/s of this Ministry/these Ministries preferred (2 maximum)<br />
_______________________________________________________________________________<br />
DECLARATION BY APPLICANT<br />
I declare that the statements contained in this application are, to the best of my knowledge, true <strong>and</strong><br />
accurate. I authorize the administrators of the LEAP to seek verification of the information provided for<br />
the purposes of determining whether to approve this application<br />
Date completed<br />
_______________________<br />
DD/MM/YYYY<br />
2
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