Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697646626959.pdf (Bahamas)
Please complete all sections below 1.

General Information: First (Given) name: Middle name: Last name: Date of birth (DD/MM/YYYY): Gender: ☐Female ☐Male Phone: Address: Email: 2.

Evidence of Identity: ID Number: ☐National ID ☐Passport ☐Driver’s License Type of ID: Expiration date (DD/MM/YYYY): 3.

Education: ☐University degree ☐High school ☐Tertiary ☐Other If applies: Name of secondary school College/university name Program of study Years of study 4.

Employment Information Are you currently employed?


☐Yes ☐No Please, provide information of your employment history for the last 5 years.

Add experiences from most recent to the oldest.

(Add rows if required).

Period-Years Organization Position Description of duties 5.
Computer Literacy, Access to Resources Check what is applicable to you 5.1 Level of computer literacy 5.2 Access to technology devices (laptop, desktop, tablet) 5.3 Access to Internet 5.4 Use of social media channels (Facebook, Instagram, Pinterest, etc.)

5.5 Use of IT tools to improve daily tasks.

Low ☐ Medium ☐ High ☐ Very high ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ 5.6 Are you familiar with digital technologies?

☐Yes ☐No 5.7 If yes, list some of the technologies you may have used.
5.8 Are you certified in any of these digital technologies you mentioned?

☐Yes ☐No 5.9 In light of the Covid-19 pandemic, do you, as an individual, further see the need for digital skills?

☐Yes ☐No 5.10 Why are you interested in the digital skills training?

6.

Emergency Contact Full name: Phone number: Address: Relationship to you: Email: 7.

References Please provide the names and contact numbers of 2 persons whom we can call to conduct a reference check.
References from family or relatives are not acceptable or valid.

Name Organization and position Address/contact number(s) How many years have you known this person?

8.

6.

Personal History Have you ever been charged/convicted of a criminal offence?

☐Yes ☐No If yes, state nature of offence:  Are there any health-related issues, illnesses, disabilities, or current conditions that could affect your attendance?

☐Yes ☐No If yes, please describe:  Are you physically challenged/impaired in any way?
☐Yes ☐No If yes, please describe:  Have you been treated for any illnesses during the last six (6) months?

☐Yes ☐No If yes, please describe: I certify that answers herein are true and complete to the best of my knowledge.

I authorize The Avasant Foundation to make investigations and enquiries regarding my personal history and other related matters as may be deemed necessary.

Candidate signature: Date: