Apprenticeship Training Employment and Development (RATED) Programme

REGISTRATION FORM
Please read carefully before proceeding to complete this application:
1. The RATED programme is open to unemployed Virgin Islanders/Belongers ONLY.
2. If you are employed on a full-time basis, you are NOT eligible to participate in this programme.
3. Public Officers are NOT eligible to participate in this programme.
4. You must submit a copy of a valid Belonger Card or British Overseas Territory Citizen (Virgin Islands) Passport
in support of this application.
Please ensure that the application form is completed clearly.
*Required Fields (Sections MUST be completed)*First Name:PERSONAL INFORMATION*Middle Name:*Surname:*Physical Address:*District where you live:*Contact Number(s):*Date of Birth (D/M/Y):For Official
Use

Email:*Age:*Gender:*Are you a Virgin Islander/Belonger?
☐ Yes☐ No (If No, please see note #1 above) (NOT ELIGIBLE)*Belonger Card No:*Passport No:*Social Security No:*Tax ID Number:Driver’s License No:*NHI Number:

If No Give
Reason(s):*Emergency Contact (Full Name and Contact Number):Name:_____________________________________ Contact Number: ______________________EMPLOYMENT STATUS*I am:☐ presently unemployed and not receiving any income☐ presently employed on a part-time basis*Place of Employment: _____________________________________________________*Days of Work: __________________________________________________________*Hours of Work: Begin: __________________________ End: ___________________________☐ presently self-employed and not receiving any income☐ presently employed on a full-time basis (Please see note #2 above) (NOT ELIGIBLE)SKILLS & WORK EXPERIENCE*Please list your highest level of education attained:*Have you supervised before? ☐ Yes ☐ NoRegistration
accepted?
☐ Yes
☐ No

*Largest Team Supervised:☐ 1 – 10 ☐ 11- 25 ☐ 26 - 40 ☐ 40+

*Please list your work experience, if applicable: (May use separate sheet if necessary)*Programme Pathway of Interest:☐ Temporary Employment☐ Apprenticeship☐ Training and Education*Areas of Interest (Please select THREE (3) ONLY):
If an area of interest is not listed, please indicate in the category ‘Other’___ Landscaping/Bush Cutting___ Painting (curbs/guard rails, etc.)___ Ghut Cleaning___ Waste Management___ Construction___ Carpentry___ Electrician___ Plumbing___ Repairs to Recreational Facilities andother spaces___ Agriculture/Fisheries___ Marine/Yachting___ Trucking Services (3yd Truck)___ Communications/Public Relations___ Administrative/Clerical Work___ Data entry/Digitisation of paper records___ Culinary/Hospitality/Tourism___ Legal/Professional Services___ Goods and Services___ Janitorial Services___ Financial/Insurance___ Statutory Body/Agency___ Health Sector___ Education___ Wholesale/Retail Trade___ Real Estate___ Other ____________________________*Indicate tools currently owned (if applicable):☐ Weed Eater ☐ Machette/Cutlass ☐ Sweeper Broom ☐ Hedge Sheers (Clipper) ☐Other_____________*Are you physically able to perform the type of work selected?

☐ Yes ☐ No

Please list any disabilities you may have:*Declaration:I,, declare that the information submitted on this form, isaccurate to the best of my knowledge. I understand that submission of false information can adversely
affect my approval to participate in the RATED Programme. I also agree that if I am selected toparticipate in the Programme and I accept the offer presented, I will abide comply with the conditionsof the work/training opportunity and I will perform my responsibilities with diligence.
Signature:

Date:

Please check all supporting documents attached in support of your application:*Documents below with asterisk (*) must be attached to all applications, where applicable.

[ ] Belonger Card*[ ] Passport*[ ] Driver’s License[ ] Tax ID Registration[ ] Social Security Card*[ ] National Health Insurance (NHI) Card*[ ] Resume (Please attach if interested in Employment within an office setting)[ ] Diploma/Degree (Please attach if interested in Employment within an office setting)
Submit completed application form to:(Please ensure that application is completed as required and all supporting documents are attached)Permanent Secretary
Ministry of Environment, Natural Resources and Climate Change#44 Pusser’s Building, Lower Estate, Road Town, TORTOLAorDistrict Offices located on the Sister Islands