FOR STAFF USE ONLY Work permit number Republic of Somaliland FORM: F1 MINISTRY OF LABOUR AND SOCIAL AFFAIRS APPLICATION FOR A WORK PERMIT Photo Important Notes: Please Read these notes before completing the form 1. This form must be completed fully in block letters. Any application that contains omissions or is incorrectly completed will be returned to the applicant for completion 2. Work permits are normally issued for a period not more than a year. 3. Application for a work permit should be made at least 3 weeks before the foreign national is required to take up employment. 4. Application for a renewal work permit should be made at least 12 weeks before the foreign national current permit expires. 5. In the case of a renewal application, the employee must hold a passport which is valid for at least 12 months 6. One form should be completed by each applicant however were a family Is applying for permits at the same time as the principal applicant the other spouse and their children under 21 years complete a separate form is when they enter the Somaliland separately from the family and their permits were not applied for at the same time 7. Copies of marriage certificate (if appropriate) should be attached with all children s birth certificate if permits are required for them. 8. Applicants are required to submit attested copies of their qualification certification, CV, passport employment contract, etc. but the MOLSA reserves the right to call for original documents. 9. Employers and employees must note that if approved the work permit will be subject to the following and any other additional conditions contained there in (1) the employee is but allowed to work for any employer or perform any other occupation other than that or those listed in this application, and (ii)the permission of the employee to remain and work in the Somaliland ceases in the event that the work permit expires revoked or if there employment contract is terminated 10. An application for an employment permit shall be accompanied by the requirement prescribed below: i. Application letter done by employer to the Ministry of Labor and Social Affairs ii. Completed form F1 iii. Two passport sized photographs (4.5x3.5 cm) color or black and white ) taken with in the last six month with employee s name printed on the back iv. Copy of passport pages showing photograph personal details and export date v. Copy of curriculum vitiate including work experiences vi. Copy of educational diploma /certificate vii. Copy of work contract 11. Services charges for work permit is $500 for one year SECTION 1: PERSONAL DETAILS OF THE EXPATRIATE Ministry of labour and social affairs -application for work permit ( form f1) Page 1
First application: Renewal: Expired permit number 1.1. Name of the applicant: Surname /family Name PRADHAN-BLACH Given name RIMA DAS 1.2. Preferred title: MR Mrs. Ms miss Other 1.3. Gender : Male Female 1.4. Date of Birth : 1.5. Nationality : AUSTRALIAN 1.6. Marital status: Single Married Divorced Widowed 1.7. Addresses : I. Permanent address in the overseas country Address : Telephone : +45 2877 2204 VESTER VOLDGADE 4, LEVEL 3 Fax: 1552 COPENHAGEN V Mobile : +45 2877 2204 DENMARK e-mail : RDPB@ME.COM 1.8 indicate details of dependents such as spouse and all children under the age of 18 years who will stay with you in Somaliland ( please attach certified copies of marriage and birth ) Full name (surname first ) Date of birth Country of birth Sex Passport number Ministry of labour and social affairs -application for work permit ( form f1) Page 2
1.9 passport details I. Name as given in the passport: RIMA DAS PRADHAN-BLACH ii. Passport No: E4031732 iii country of issue: DENMARK iv. Date of issue: 18 06 2010 V. Date of Expiry: 18 06 2020 1.10. What is your main occupation? SENIOR ADVISOR, DANIDA SOMALILANDFUND 1.11. List all periods of previous employment including self employment attach the (CV) Date from DD/MM/YY Date to DD/MM/YY Name of employer Location Type of work /job title Ministry of labour and social affairs -application for work permit ( form f1) Page 3
1.12. Give details of all qualifications you hold (attach copies of certificates) Name of qualification Date obtained DD/MM/YY Institution where gained 1.13. Expatriate s Declaration I, hereby solemnly declare that the particulars given above are true and correct to the best of my knowledge. I realize that I shall not be able to undertake employment in the Somaliland unless I first secure an appropriate permit to work from the Somaliland government particular MOLSA. I understand that my work permit will be cancelled in an event where it is proved to the Somaliland government that the above information is incorrect Name of the expatriate: RIMA DAS PRADHAN-BLACH Signature. Date.. SECTION II: DETAILES OF THE EMPLOYER (to be filled by the organization) 2.1 type of the organization UN INGO LNGO Other 2.2. Name of the Organization: 2.3. Registration number: Ministry of labour and social affairs -application for work permit ( form f1) Page 4
2.4. Address. Address: Telephone : Fax: Mobile : E-mail: SECTION III: DETAILES OF THE POSITON (to be filled by the organization) 3.1. Job title of the expatriate: 3.2. Place at which the employments will b e carried out: 3.3. Registration number: 3.4. Qualifications required for the post 3.5. Type of experience required for the post Ministry of labour and social affairs -application for work permit ( form f1) Page 5
3.6. Length of experience required Validity period of employment: i. Date the expatriate will arrive in Somaliland ii. Date the expatriate will finally depart 3.8. Detail the attempts you have made to recruit Somaliland citizens to fill the position by answering the questions set out below i. Did you advertised the past Yes: No: ii. If no this position needs to be advertised iii. If yes provide details of the advertising media used and duration of advertisement News paper Duration of advertising Issues dates Ministry of labour and social affairs -application for work permit ( form f1) Page 6
3.9. Number of applicants received: 3.10. Explain why the Somaliland applicants were not suitable. (Failure to provide an adequate explanation will result in this application being refused. 3.11 Employers declaration We hereby declare certify that all the above information is true to the best of our knowledge and belief We agree to comply with all the requirements in this form and to submit all the document requested there in We agree to comply fully with the terms and conditions of the permit to employ that my be issued as a result of this application Name of head of the organization:.. Position:.. Signature ---------------------------------------- date of signature (Seal of the Organization) SECTION IV: OFFICIAL USE (to be filled by an authorized officer of MOLSA) 4.1 Date application received: 4.2 Type of application: first time Renewal 4.3 If it is Renewal application, state Previous work permits NO. New work permit No. Ministry of labour and social affairs -application for work permit ( form f1) Page 7
Starting date : Date of Expiry : 4.5 Check list of the accompanying documents i. Passports Details yes No ii. 2 photos of passport size yes No iii. Qualification ( certificates) yes No iv. Curriculum vitae (cv) yes No v. Contract of employment yes No vi. Work permit fee ( if applicable ) yes No 4.6 Recommendation. Mr. Director of labour department Signature:.. Date:. Approved Subject to Ministry of labour and social affairs -application for work permit ( form f1) Page 8
Deferred Reused Reason. Reason Mr. Director General Signature.. Date: --------------------------------------- Official seal ------------------------------ Ministry of labour and social affairs -application for work permit ( form f1) Page 9