4. EMPLOYMENT RECORD OF APPLICANT (to cover full period of employment):
Name of employer
Address:
Town/City
From
To
Nature of work
2
5. DETAILS REGARDING APPLICANT AND (if applicable) SPOUSE AND CHILDREN:
Have you or any of your dependants accompanying you ever been convicted of any
crime?
Is
a criminal
or civil
case pending against you or any of your dependant
accompanying you?
Are you or any of your dependants suffering from tuberculosis or any other infectious
or contagious disease or any mental or physical deficiency?
Are you a member of, or adherent to an association or organisation advocating the
practice of social violence, or racial hatred?
If you replied to any of the questions above in the affirmative, please furnish full details.
6. SECTIONS OF THE REGULATION THAT MUST BE WAIVED
264
No. 37679
GOVERNMENT GAZETTE, 22 MAY 2014
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