permission to continue working...

IMM/PCW/PTW/FPW (2017/05) P1

PERMISSION TO CONTINUE WORKING APPLICATIONThis application should be addressed to:

The Chief Immigration Officer, Department of Immigration, PO Box 1098, Grand Cayman KY1-1102, CAYMAN ISLANDS

PLEASE DO NOT LEAVE ANY QUESTION BLANK. IF A QUESTION DOES NOT APPLY TO YOU, INSERT, “NOT APPLICABLE” OR “N/A” IN THE SPACE PROVIDED.

NOTES: (i) The Applicant must have a valid passport. (ii) This application is in two parts. The first part is to be completed by the Employee and the second part by the Employer or the self-employed. (iii) Refer to the checklist accompanying this form for additional documents required to process this application. (iv) Use separate sheet of paper, where necessary. (v) Retain a copy of all applications and attachments you provide Immigration.

P1

of 8

1. Surname (Last Name) Maiden Name Given Names (First Names)

2. Nationality 3. Date of Birth

5. Passport number 6. Date of Issue 7. Place of Issue 8. Date of Expiry

10. Personal Email

DD/MM/YY

DD/MM/YY DD/MM/YY

9. Any other names known by

PART 1 - To Be Completed By Employee

11. Address

13. PO Box and KY12. District 14. Telephone:

15. Have you, or any dependant accompanying you, ever been charged or convicted of a criminal offence in any country? If yes, please provide details of ALL offences.

Nature of offence Date Location Verdict and Sentence

DD/MM/YY

17. Are you presently in good health? Yes No16. Term Limit Date

18. Particulars of any dependant(s) previously approved on work permit or final work Permit

Name Date of Birth Nationality Relationship

DD/MM/YY

I declare that the information provided above by me is true and correct and I understand and accept that if it is proven that I have made a false statement I am liable on conviction to a fine of CI$5,000 and imprisonment for one year. By signing below I also understand and accept that if this application is approved any and all conditions contained in the Work Permit must be complied with. In accordance with The Immigration Law, I hereby agree to submit to being Fingerprinted/Palm-printed for the purpose of identity verification and criminal checks domestically and internationally.

EMPLOYEE'S DECLARATION:

Signature of Employee - Original Signature Required Date (DD/MM/YY)DD/MM/YY

4. Gender Male Female

File/Worker Ref No. (if known)

19. If your permanent residence application is pending with the Board/Chief Immigration Officer has any of your circumstances changed since it was submitted? Yes No

If yes, have you notified the Board/Chief Immigration Officer of those change of circumstances? Yes No

DD/MM/YY

DD/MM/YY

1. Awaiting decision on application for Permanent Residence - valid for 6 months (PCW)

2. Awaiting decision on permanent residence refusal appeal from Immigration Appeals Tribunal - valid for 6 months (PCW)

4. Requesting final permission to work (appeal dismissed)- valid for 90 days only (FPW)

DD/MM/YYDate Appeal filed (if any)

Yes No

3. Awaiting decision on permanent residence refusal appeal from Grant Court (Judicial Review) - valid for 6 months (PCW) DD/MM/YYDate Appeal filed (if any)

Permission To Continue Working

IMM/PCW/PTW/FPW (2017/05) P1 of 8

PART 2 - To Be Completed By Employer

Notes: • A worker awaiting the decision of a residency and employment rights certificate from Chief Immigration Officer/The Caymanian Status and Permanent Residency Board or a

decision from the Immigration Appeals Tribunal is entitled to work for a different employer, but in the same occupation as stated in his final work permit. They must first have their new employer submit a new Permission To Continue to Work application (Form P1).

• Once a decision is made and communicated by the Immigration Appeals Tribunal, the Permission To Continue to Work authorization falls away, at the expiration date, and the worker must regularize his immigration status immediately following the date of expiration.

• A turn around time of 3 working days is to be expected on this request.

Signature of Employer Original Signature Required - Agency Signature not acceptable Date (DD/MM/YY)

Signature of Additional Employer (if applicable) Original Signature Required - Agency Signature not acceptable

Date (DD/MM/YY)

DD/MM/YY

DD/MM/YY

1. Name of Individual (Personal) Employer

2. Surname (Last Name) Maiden Name

Gender: Male Female

Given Names (First Names)

3. Nationality Date of Birth DD/MM/YY

4. Address

PO Box and KY5. District E-Mail

Home6. Telephone - Work Cell

1. Name of Business/Company Employer

Name and contact information of additional employer if being shared (should have been previously approved by C.I.O. or the Board when work permit was in effect)

12. Address

PO Box and KY13. District

14. Telephone - Work Cell

11. Additional Employer Name

9. State under which Law this business is licensed to operate

7. Occupation to be filled

10. Trade & Business number, if applicable

8.How much is the worker receiving in salary or wages? per day per week per month

Name of Employer

I declare that the information given above is correct and confirm that the employee for whom the work permit is being sought is or will become a member of the above Health Insurance Plan in accordance with the Health Insurance Law and is a member or will join the above Pensions Plan in accordance with the National Pensions Law. I understand that I will be responsible for any medical expenses incurred by the employee and their dependants in the absence of a standard health insurance contract. I understand making a false statement or representation knowing the same to be false in accordance with the Immigration Law, I am liable on conviction to a fine of up to CI $5,000.00 and imprisonment of one year.

Authorized signatory for and on behalf of Employer

Date (DD/MMM/YY)

Supplement - To Be Completed By Employer and Attested To By The Employee

Yes No

Registration No

Telephone No

1. Do you have a valid Pension Plan for this employee in accordance with the National Pensions Law and its current revisions?

2. What is the name of the Company and Administrator of your registered Pension Plan?

PENSION PLAN

Company

E-Mail Address

3. Are your Company's Pension Plan contributions for this employee paid up to date? Yes No

If No, why not?

Employee Pension No

HEALTH INSURANCE

1. Do you have a valid Health Insurance Plan for this employee in accordance with the Health Insurance Law and its revisions and regulations thereunder?

Yes No3. Are your health insurance premiums for this employee paid up to date?

Name of Employee

Signature

Date (DD/MMM/YY)

EMPLOYER'S DECLARATION: EMPLOYEE'S DECLARATION:

Policy No

Telephone NoCompany

E-Mail Address

Yes No

2. What is the name of the Company and Administrator of your registered Health Insurance Plan?

I declare that the information given above is correct and confirm that the employer from which I seek employment has or will enrol me in the Health Insurance Plan and has or will enrol me in the above Pension Plan (unless exempted by Pensions Law). I understand making a false statement or representation knowing the same to be false in accordance with the Immigration Law, I am liable on conviction to a fine of up to CI $5,000.00 and imprisonment of one year.

Employee Membership No

If No, why not?

If No, why not?

IMM/H&P (2016/12) HP001 of 8

Health Insurance and Pension - Supplement To Work Permit Application (Temp/Grant/Renewal)

Questions relating to the Provision of Pension Benefits and Health Insurance

Original Signature of Employer Required!, cannot be Agency signature

www.immigration.gov.ky www.gov.ky/immigration

If No, why not?

D/MMM/YY

D/MMM/YY

Original Signature of Employee Required!, cannot be Agency signature or Employer

In accordance with the Health Insurance Law every person, and their dependants, resident on Island must have health insurance coverage effected by their employer.

Print Name

In accordance with the National Pensions Law after an employee has completed 9 months of employment in the Cayman Islands, the enrollment & payment of pension contributions are mandatory.

1. Name of Employee

2. Name of Employer

5. Type of Building ApartmentDwelling House

6. How many rooms are available for the employee and his/her family?

Bedrooms Bathrooms Living Rooms Kitchens

7. Will any of these rooms be shared with other occupants of the dwelling? NoYes If Yes, give details - including number of other occupants and which rooms

8. This accommodation is Owned by the Employer Owned by the Employee Rented by the Employer Rented by the Employee

9. If Rented, what is the period of lease?

Block and Parcel No

10. If Rented, the name and address of the Landlord/Rental Agency is

(i) House No (ii) Street Name

I understand and agree that a representative of the Department of Immigration may be required to view the premises described above at any reasonable hour of the day. I declare that the information provided above by me is true and correct and I understand and accept that if it is proven that I have made a false statement, I am liable on conviction to a fine of CI $5,000 and imprisonment for one year.

4. Employee's Physical Address

PO Box and KYDistrict Telephone

Hotel

(iv) PO Box and KY(iii) District (v) Telephone

-

AC001

It is a Government requirement that suitable accommodation must be available for the employee and for any dependants. Accordingly, this form must be completed in full by the Employer, attested to by the Employee and Landlord/Rental Agent, and submitted along with the Work Permit Application Form.

Accommodation Supplement

IMM/ACC (2017/01) AC001 of 8www.immigration.gov.ky www.gov.ky/immigration

Print Primary Employer Name Primary Employer Signature Original Signature required, may be Agency Signature if Agency authorised to sign by Employer

Date (dd/mmm/yyyy)

Print Employee Name Employee Signature Original signature required, cannot be Agency signature

Print Owner/Landlord/Rental Agent Name (if any) *Must be signed if Applicant is on Island

Owner/Landlord/Rental Agent (if private dwelling) Original Signature required

DD/MMM/YY

Date (dd/mmm/yyyy)

DD/MMM/YY

Date (dd/mmm/yyyy)

DD/MMM/YY

3. Is the perspective Employee on Island? NoYes If No, move to question 11.

11. When the Employee arrives on Island, to work, please advise on their proposed accommodation:

Physical Address:

PART 1 - QUESTIONNAIRE (to be completed by Applicant)

1. (a) Surname (Last Name) Maiden NameGiven Names (First Names)

(b) Nationality (d) Date of Birth (e) Passport no (c) Country of Birth

DivorcedMarried(g) Marital Status Separated Widowed Single

2. Have You Ever Had Or Currently Have Yes No Yes No

(a) Nervous or mental trouble

(f) Frequent or prolonged indigestion?

(k) Diabetes?

4. Do you take habit forming drugs?

(o) A physical defect?

(n) Any illness or injury not mentioned above?

(m) Family history of mental trouble, suicide, fits, any kind of tuberculosis, diabetes or raised blood pressure?

(l) Rheumatic Fever?

(j) Any serious operation?

(i) Eye trouble?

(h) A sexually transmitted disease?

(g) Malaria, dysentery or any other tropical illness?

(e) Contact with a case of tuberculosis?

(d) Lung tuberculosis, Asthma or hay fever?

(c) Heart trouble or raised blood pressure?

(b) Fits or convulsions?

5. Have you ever applied for or received disability benefits?

6. Are you now in good health? No Yes If No, give details

If Yes, how many months No Yes 7. Are you now pregnant? Not Applicable

Signature of Applicant

Medical Examiner/Physician

Date (dd-mmm-yy)

(f) Gender Male Female

3. Do you consume alcohol?

If Yes, how many alcoholic drinks do you typically consume in 1 week

If Yes, explain

If you have answered Yes to any part of questions 2, explain

Yes No

Yes No

Yes No

If Yes, explain

CAYMAN ISLANDS IMMIGRATION DEPARTMENT GUIDELINES TO MEDICAL PRACTITIONERS

MEDICAL EXAMINATIONS FORM

1. Medical examinations are required with the initial work permit application. The Medical examinations are valid for three (3) years. 2. Laboratory tests have to be repeated with each medical examination. The Laboratory Reports are valid for six (6) months. 3. Chest X-rays are required with the initial work permit application. Chest Xrays are valid for five (5) years. 4. Laboratory Reports have to be attached for HIV and VDRL tests. 5. Medical practitioners are advised to perform any tests that might be desirable depending on the disease prevalence in the respective countries. 6. The Medical Examinations Form must be signed and stamped or sealed by Physician. 7. The Laboratory Report must be signed and stamped or sealed by Lab Technician or Physician. 8. Immigration reserves the right to require additional medical examinations at any time.

MEDICAL FORM CONTAINS 8 PAGES

IMM/WP MD001 (2014/09) of 8www.immigration.gov.ky www.gov.ky/immigration

Original Signature Required

D/MMM/YY

D/MMM/YY

D/MMM/YYDate (dd-mmm-yy)

PART 2 - MEDICAL EXAMINATION (to be completed by Medical Examiner)

Yes No

1. Is the Examinee personally known to you?

If No, did you check ID?

Signature Medical Examiner

2. Height feet in. Weight lbs. (in under clothes) Waist in.

Chest measurements on respiration in, on expiration in.

3. Blood pressure (two readings: at rest (sitting) lying down Pulse rate

4. Date and report of last E.C.G. if any

5. Are the following free from any pathological condition or abnormality;

(a) Skin

(f) Abdomen

(h) Respiratory System

(i) Locomotor System

(k) Genito-Urinary System

(j) Nervous System

(g) Cardiovascular System

(e) Nose

(d) Ears

(c) Eyes

(b) Throat & Mouth

Yes No

If No to any of the above questions, provide details

6. Is the examinee on any drug therapy at present?

7. Give details of any operations

8. Medical conditions

Date of Examination (dd-mmm-yy)

If Yes, give details No Yes




a) b)

c) d)

D/MMM/YY

PART 3 - XRAY AND LABORATORY INVESTIGATIONS (to be completed by Medical Examiner

(a) Hospital Xray No. Date Result

(b) Urine: Date Albumin Sugar

(c) Blood Tests (attach laboratory reports)

HIV SCREEN

VDRL

TESTS DATE RESULT

(d) Other tests (depending on history and disease prevalence in the country of origin)

TESTS DATE RESULT

Name and address of Medical Examiner

Qualifications Medical Registration Number

Address of Registering body

Signature Medical Examiner

FOR OFFICIAL USE ONLY




Date of Examination (dd-mmm-yy) D/MMM/YY

D/MMM/YY

D/MMM/YY

D/MMM/YY

D/MMM/YY

D/MMM/YY

D/MMM/YY

D/MMM/YY

IMM/CKL (2017/06) CKLP1 of 8

PERMISSION TO CONTINUE TO WORK - CHECKLISTThis list is a summary of general requirements for ALL applicants. The Chief Immigration Officer reserves the right to request additional information or documentation as deemed

necessary.

Application forms duly completed, signed and dated by employee and employer.- original signatures required. Please do not leave any question blank. If a question does not apply to you, insert "not applicable" or "n/a" in the space provided.

Cover letter signed by Employer with detailed summary of why the Permission To Continue to work is required.

Correct fee: CI$100 application fee and 50% of annual work permit fee (6 months)

Proof of enrollment in a pension plan

Proof of enrollment in a health insurance plan

Original medical questionnaire, if applicable, as the full medical is only required every 3 years, including the original HIV/VDRL lab report (HIV/VDRL is required every twelve months).

A copy of the appeal fee receipt (where an appeal has been filed)

Where the Trade Business Licence has expired, a copy of the receipt of payment for renewal from employer

Original signed and sealed, Police Clearance certificate - less than 12 months old

permission to continue working...

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