Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697629767564.pdf (Antigua and Barbuda)
APPLICATION FORM FOR EMPLOYMENT WITH THE 2011 POPULATION AND HOUSING CENSUS Form CO-10-001 2011 Census Office Statistics Division Ministry of Finance, the Economy and Public Administration Please note that the accuracy of the information you have provided will be verified SECTION A: Applicant's Personal Information 1.

Social security number (where applicable) 8.

Please indicate your immigration status 2.

Please provide your full name Last name First name 3.
Date of Birth National Citizen Permanent Resident Other ……………………………… (If you are not a national of Antigua and Barbuda, please attach to this application form, a photocopy of your passport page bearing the immigration stamp) MI 9.

Select the highest level of education attainment Post Graduate Post Secondary Day Month Year Graduate Secondary 4.

Sex (Mark an X in one box) Non Tertiary Other ……………………………….. Undergraduate Vocational/Skills Training Female Male 5.
Residential Address Apt # - house / building name Street address Village Parish 6.

E-mail address 7.

Telephone numbers Home Work Other - - - 10.

Language Skills (Please indicate with an X your ability to communicate in a foreign language.

Enter language and check all that apply.

Language Speak Read Write I am not able to communicate in another language 11.
Please indicate the type of transportation that is available to you, and which you are likely to use for the Census field work Automobile 4-wheel drive Motor Bike / Bicycle Other ………………………… I do not have access to any type of transportation 1 SECTION B: Information about the Census Jobs Form CO-10-001 Most field positions require dealing with the public, knocking on doors to collect information that may not be discussed or shared with anyone except for sworn Census Office employees 12.
Are you willing to work in the field, verifying household address listings and knocking on doors to collect information?

16.

Please indicate your availability for training and Census field work by placing an X in the appropriate box(as) for each category (Any Hours or Part-time) Any hours Yes No Sun Mon Tue Wed Thur Fri Sat 13.

There are four categories of field officers.

Select the one in which you are most interested.


(See page 3 for explanation of duties) Part-time Sun Mon Tue Wed Thur Fri Sat Enumerator Supervisor Liaison Data Processors M A E 14.

Have you ever worked in a Census or Survey?

M - Morning (8am to 12 pm) A - Afternoon (12pm to 4pm) E - Evening (4pm to 9pm) 1991 Census 2001 Census Survey …………………………………… I have never worked in a survey or census 15.

Are you currently employed?

Yes No If yes, provide the name and telephone number of your employer 17.
Enter in the box to the right, the total hours per week you are willing to work.

You may only work up to 40 hours per week NOTE: Census jobs will be available for two periods: October to November 2010; and May to August 2011.

Selected applicants will be notified of any changes in these dates.

SECTION C - Background Information 18.

During the past 5 five years have you been fired from any job for any reason?

Questions 18 to 22: Provide the date, explanation of the violation, place of occurrence.
Yes No 19.

During the past 5 five years did you quit after being told that you would be fired?

………………………………………………………………………………… Yes No ………………………………………………………………………………… 20.

During the past 5 five years did you leave any job by mutual agreement because of specific problems?

Yes No 21.

During the last 10 years, have you been convicted, imprisoned, on probation, or on parole?
(Includes felonies, firearms or explosives violations, misdemeanours, and all other offenses) ………………………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… Convicted Imprisoned Probation Paroled Charged ………………………………………………………………………………… ………………………………………………………………………………… None of the above apply to me ………………………………………………………………………………… 22.

Are you currently facing charges for any violation of the law?
………………………………………………………………………………… Yes No 2 SECTION D: Signature, Certification and Release of Information Form CO-10-001 Read the following statement carefully before you sign the form.

A false statement on any part of your application may be grounds for not hiring you or for releasing you from your duties.

I certify that, to the best of my knowledge and belief, all information contained in this application and in the accompanying attachments (if required) is true, correct, complete, and made in good faith.
I also authorise the 2011 Census Office to contact without further notice, any person/individual, company or institution etc.

for the purpose of verifying information in this application.
Further, I agree to notify the 2011 Census Office immediately of any material change in this application Signature: Date (d/m/y) Description of field workers' duties The work of enumerators will usually involve a mixture of: (a) interviewing respondents which will involve representing the census office, answering queries about the Census and providing assistance, as needed (b) clerical work at home and in the field, which will involve understanding and applying procedures and guidelines, and providing feedback (c) travel to and from, and around, the enumeration area Enumerator During the peak enumeration period, enumerators will spend most of their time in the field.
Therefore, they can only report to their supervisor in the evenings, or on their way to or from their enumeration area.

Supervisors play a critical role in assessing and reviewing the performance of enumerators and ultimately influencing the quality of the census.

The supervisor is also an important link in terms of evaluating the procedures, documentation and training for census tests.
The roles of a supervisor are to: (a) provide retraining of enumerators who require it following their initial training course; (b) enhance the enumerators’ performance through practical advice (c) provide support and encouragement (d) provide contact, open communication and feedback (e) perform quality assurance on enumerators’ work (f) ensure recommended improvements are implemented Supervisors Supervisors will need to locate and meet their enumerators in the field to check on progress, problems and any communications issues.
The role of the Liaison Officer involves: (a) public communications activities to promote census awareness (b) quality assurance - For example, in recruiting and selecting enumerators, they could be responsible for vetting selections and approving appointments Liaisons Liaisons may be responsible for approving payment of stipends and travel expenses for enumerators and supervisors.
Data Editors and Coders Data editors are responsible for perusing each questionnaire to ensure that they are correctly completed.

Data coders are responsible for applying codes to each questionnaire prior to entering the data into the information system.
Please submit the completed form to: 2011 Census Office 3rd Floor ACT Building Market & Church Streets St Johns | Antigua Tel: :(268) 562-3045, 562-1951 FAX: (268) 562 2542 email: AntiguaBarbuda2011Census@gmail.com Office use - Special Notes: Indicate how you found about the Census jobs Office Use only Database # Newspaper Facebook Gov't webpage TV Radio Other.

specify: ……………………….

Form submitted by: Regular Mail In person E-mail Fax Stamp 3