British Immigration Service
Visa/Permits Services Directorate
40 Wellesley Road
Croydon - CR9 2BY
England
WORK PERMIT APPLICATION FORM
YOU ARE: EMPLOYER EMPLOYEE STAFF AGENCY
EMPLOYEES INFORMATION
TITLE: MR MRS MS MISS DR
FIRST NAME: _________________________ LAST NAME: _____________________
ADDRESS: _____________________________________________________________
CITY/TOWN: __________________________ COUNTRY: _______________________
DATE OF BIRTH: ____/____/______/ EMAIL: ______________________________
HOME TELEPHONE: __________________ OFFICE TELEPHONE: _________________
EMPLOYEERS INFORMATION
COMPANY NAME: ________________________________________________________
ADDRESS: _____________________________________________________________
TOWN/CITY: _______________________ COUNTRY: __________________________
JOB DETAILS
JOB TITLE (DESIGNATION): _____________________________________________
JOB DESCRIPTION: _____________________________________________________
SALARY LEVEL: _________________ INTENDED START DATE: ____/____/______/
EMPLOYEES WORK EXPERIENCE
1. WORK EXPERIENCE
DATE OF EMPLOYMENT: FROM: ____/____/______/ TO: ____/____/______/
COMPANY NAME: ________________________________________________________
ADDRESS: _____________________________________________________________
JOB TITLE: ___________________________________________________________
2. WORK EXPERIENCE
DATE OF EMPLOYMENT: FROM: ____/____/______/ TO: ____/____/______/
COMPANY NAME: ________________________________________________________
ADDRESS: _____________________________________________________________
JOB TITLE: ___________________________________________________________
I ________________________________________ hereby accept that I
shall utilize my visit for which Work permit has been applied and
shall not on arrival in England try to use my permit for any other
purpose. I also declare that I have received a contract/agreement
letter from my employer before applying. I declare that all
information given here is true, accurate and complete.
DATE: ____/____/______/ SIGNATURE: _____________________________
NOTE: MISLEADING/FALSE INFORMATION WILL RESULT IN REJECTION OF WORK
PERMIT APPROVAL WITHOUT ANY REASON. ALL INFORMATION MUST BE FILLED WITH
BLACK INK. PROCESSING FEE IS NON-REFUNDABLE AND SUBJECT TO CHANGE WITHOUT
NOTICE. PASSPORT PHOTOGRAPH MUST BE TAKEN ON A PLAIN RED BACKGROUND ONLY.