GOVERNMENT OF BERMUDA APPLICATION FOR EMPLOYMENT

Public Ser vice Commission All sections to be completed in applicant’s own handwriting, regardless of whether
applications have been submitted for this or other Government posts in the past.

1. POST APPLIED FOR: Reference No.:

(As quoted in advertisement)

Post Title:
Ministry:
Department: Salary Scale:

2. PERSONAL DETAILS: Please circle one Dr. Mr. Mrs. Ms. Miss E-mail Address:
Name (print):
Telephone Numbers: Home Work Cell
Street Address:
Mailing Address:

3. a) Bermudian q b) Spouse of Bermudian q c) Non-Bermudian q

Date of Birth: Day: Month: Year:

4. EDUCATION: (To be completed IN FULL by all applicants.)

Schools, Colleges, Universities attended Full or Part-time Entered Left

Academic, Professional, Technical qualifications obtained (in full) Date Obtained

Special courses undertaken relative to the post applied for:

5. THIS SECTION TO BE COMPLETED BY APPLICANTS CURRENTLY EMPLOYED BY GOVERNMENT.

A Government employee must present this completed application form to his/her Head of Department for signature before
submitting it to the Public Service Commission.

Current Post:_____________________________________ Salary Scale:_ _______________________________________________

Department:______________________________________ Date Commenced:___________________________________________

TO BE COMPLETED BY YOUR HEAD OF DEPARTMENT ONLY:

Signature:__________________________________________________ Date___________________________________________

Print Name:_ _______________________________________________

6. THIS SECTION TO BE COMPLETED BY EXTERNAL APPLICANTS ONLY.

Name of current employer:

Post Held:

Current Salary: Date Commenced:

Reason for wishing to leave:

(All information given under paragraph 6 will be treated in strict confidence.)

7. PREVIOUS EMPLOYMENT:
Name of Employer Post Held Date Started Date Left Reason for Leaving

Are you in receipt of a pension earned from previous Government employment? Yes q No q
If the advertisement for this post requires you to be able to lift and/or have a valid driver’s licence please answer the following questions:
Are you able to meet the lifting requirements? Yes q No q
Do you have a valid Bermuda driver’s licence? Yes q No q

8. PROFESSIONAL REFERENCES: Provide TWO referees (i.e. current/previous supervisors), NOT relatives or members of the Legislature
Name: Name:
Address: Address:

Working Relationship: Working Relationship:

E-mail: Tel: E-mail: Tel:

9. ADDITIONAL INFORMATION:
Please state in your own words why you are an applicant for this post, mentioning any specific achievements or personal qualities which
you think may support your candidature: (Attach an additional sheet if necessary.)

10. HAVE YOU EVER BEEN CONVICTED BY A COURT OF LAW? Yes q No q IF YES, GIVE DETAILS:
(You need not answer “YES” to this question if you are entitled to be treated as rehabilitated under the Rehabilitation of Offenders Act 1970.)

11. NOTICE TO APPLICANTS

Appointments to Government Service are made under the Public Service Commission Regulations 2001. Attention is drawn to the
provisions of Regulation 20 whereby any person who canvasses any member of the Commission or of the Legislature in connection
with the appointment of any person to any Office shall be disqualified for appointment to an Office.
I CERTIFY, to the best of my knowledge, that the information contained in this application is a true and factual record. I understand
that should the information provided prove to be incorrect or misleading, then the appointment, whether offered or in effect, may
be cancelled.

Date: Signature:
 RECEIPT
Department of Human Resources
APPLICANTS PLEASE COMPLETE FOR 3rd Floor, Ingham and Wilkinson Building
ACKNOWLEDGEMENT RECEIPT 129 Front Street – Hamilton HM 12 BERMUDA
Phone: (441) 279-2820 Fax: (441) 295-2858
E-mail: hr@gov.bm Website: www.gov.bm

Name: __________________________________________________________
Address:_________________________________________________
_________________________________________________
_________________________________________________

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Post Title: _________________________________

Post Ref.#:_________________________________

On behalf of the Public Service Commission, we would like to take this opportunity to thank you for your
interest in this post and inform you that your application will be forwarded for consideration by the recruiting
panel.

If you are short-listed for an interview, you will be contacted by the employing Department.

We invite you to visit the Department of Human Resources’ pages on the Government of Bermuda website
at www.gov.bm for further details about our hiring practices and terms and conditions of employment.

If you have any questions pertaining to this vacancy, please do not hesitate to contact our office at 279-2824
or 279-2823, quoting the appropriate reference number.