Reference Date

Office Use Only DD MM Y Y Y Y Received by:

No: received

WORK PERMIT APPLICATION FROM

EFFECTIVE APRIL 1, 2016 (REGULATION 33(1) AND 39(1)

Turks and Caicos □ EMPLOYED

Islands
□ SELF EMPLOYED

Name of Employer

Name of Employee

Payment Voucher No.

INSTRUCTIONS:

Please write in BLOCK letters and tick ( ) where relevant.

Complete the form in its entirety.

Ensure that the necessary documents are attached.

Kindly indicate the persons who wish to accompany the temporary worker or are already residing in the
Turks and Caicos Islands.

Spouse

Child 1

Child 2

Child 3 (additional sheet required)

Child 4 (additional sheet required)

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 1

 DOCUMENTS AND FEES TO BE ATTACHED TO THE EMPLOYED PERSON’S APPLICATION

□ (1) Two photographs of the foreign worker and each person to be endorsed. Only ONE photograph of
each individual must be certified
□ (2) Certified copy of the foreign worker’s passport bio data page showing photograph and date and
place of birth
□ (3) If on island, proof of legal entry and lawful stay in the Islands
□ (4) Valid Police record (Local) for renewals. (Local and Overseas-if first time)
□ (5) Certificate of Good Health (please contact the Ministry of Health for further information)
□ (6) Confirmation of up to date NHIP and NIB contribution (if previously employed or resident in the
islands)
□ (7) Cover letter outlining the need for the work permit from the prospective employer
□ (8) Completed application form signed by the employer and applicant
□ (9) Employer’s Business license
□ (10) News Paper Advertisements
□ (11) Job description
□ (12) Employment Contract
□ (13) Academic/Professional Qualifications Certificates and Diplomas
□ (14) If not from an English speaking country evidence of proficiency in both spoken and written English

FEES

□ (1) A non-refundable Administration Fee which will be either $150.00 or 10% of the work permit fee
per application, which-ever is greater.
□ (2) Labour Clearance Fees $100.00 per application
□ (3) A non-refundable Fast Track Service Fee of $500 00 for Fast Track Service, if desired (i.e. 7 days
processing service)
□ (4) A non-refundable Repatriation Fee for each first time work permit application and/or upon a new
work permit application involving a change in employer.
□ (5) Any other fees owed to the Turks and Caicos Islands Government with respect to work permits

ENDORSEMENT OF SPOUSE / CHILDREN

□ (1) Two Photos

□ (2) Marriage certificate
□ (3) Copy of spouse / children valid passport (Bio page)
□ (4) Medical (certificate of good health)
□ (5) Police record (valid for six months)
□ (6) In the case of a child police record is need for ten (10) years and older
□ (7) A school letter is need for children (private school)
□ (8) Birth certificate of spouse and child/children
□ (9) The applicant/employer has to demonstrate that the employee’s income is sufficient to support
him/herself and family in the islands and provide for the registration of the children in a private
school.
□ (10) Applications are submitted in the same manner as work permits.
□ (11) The fee structure is a $150.00 non-refundable administrative fee, as well as a non-refundable fee
of $500 with respect to each endorsee. Both are to be paid upon application.

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 2

 DOCUMENTS AND FEES TO BE ATTACHED TO THE SELF-EMPLOYED APPLICATION

□ (1) Two photographs of the applicant and each person to be endorsed. Only ONE photograph of each
individual must be certified
□ (2) Certified copy of the foreign worker’s passport bio data page showing photograph and date and place
of birth
□ (3) If on island, proof of legal entry and lawful stay in the Islands
□ (4) Valid Police record (Local) for renewals. (Local and Overseas-if first time)
□ (5) Certificate of Good Health (please contact the Ministry of Health for further information)
□ (6) Confirmation of up to date NHIP and NIB contribution (if previously employed or resident in the islands)
□ (7) Cover letter outlining the need for the work permit
□ (8) Completed application form signed by the applicant
□ (9) Bank statement
□ (10) Valid Business License
□ (11) Proof of Ownership of Company
□ (12) Listing of Partners/Shareholders/Certificate of Incumbency
□ (13) Business and Staffing Plan including organizational structure
□ (14) Academic/Professional Qualifications Certificates and Diplomas
□ (15) If not from an English speaking country evidence of proficiency in both spoken and written English

FEES

□ (1) A non-refundable Administration Fee which will be either $150.00 or 10% of the work permit fee per
application, which-ever is greater.
□ (2) A non-refundable Fast Track Service Fee of $500 00 for Fast Track Service, if desired (i.e. 7 days
processing service)
□ (3) Any other fees owed to the Turks and Caicos Islands Government with respect to work permits

ENDORSEMENT OF SPOUSE / CHILDREN

□ (1) Two Photographs each

□ (2) Marriage certificate
□ (3) Copy of spouse / children valid passport (Bio page)
□ (4) Medical (certificate of good health)
□ (5) Police record (valid for six months)
□ (6) In the case of a child police record is need for ten (10) years and older
□ (7) A school letter is need for children (private school)
□ (8) Birth certificate of spouse and child/children
□ (9) The applicant/employer has to demonstrate that the employee’s income is sufficient to support
him/herself and family in the islands and provide for the registration of the children in a private school.
□ (10) Applications are submitted in the same manner as work permits.
□ (11) The fee structure is a $150.00 non-refundable administrative fee, as well as a non-refundable fee of
$500 with respect to each endorsee. Both are to be paid upon application.

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 3

 SECTION A INFORMATION ABOUT THE PERSON TO BE EMPLOYED

A1 Name of person (as printed in the Passport):

 
TITLE:
Mr. Mrs. Ms.  Dr Other (Please specify) _

Family/last name
Photo

Given /first names

A2 Other names you are known by or have ever been known by

A3 Date of Birth: DDMYYYY A4 Sex/Gender:  Male  Female

A5. Country of Birth (including province/state):

A6. Country of Citizenship (if more than 1, list all):(1) (2)

A7. Race/Ethnicity: A8 . Languages spoken: ,

A9. Principal Address Outside of Turks and Caicos Islands:

A10 Intended Address in Turks and Caicos Islands (if known):

A11 Details of all passports held. You are require to give all information as printed in each passport
PASSPORT 1 Passport 2 Passport 3
Country of Issue
Passport Number
Family Name
First/Given name
Date of Issue DD MM YYYY DD MM YYYY DD MM YYYY
Expiration Date DD MM YYYY DD MM YYYY DD MM YYYY
Place of Issue

A12 Marital Status

□ Single  Married - Date DD MM YYYY Divorced - Date DD MM YYY) Separated - Date DD MM YYYY

A13 Do you have children?  Yes – How many?  No

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 4

 You are required to complete each section below regarding the present and/or previous TCI immigration
status of the person who is be employed in the islands.

Immigration details for the person to be employed in the Turks and Caicos Islands.
A14 Work Permit Holder  Temporary  Annual  Never Worked

Employer Job Title/Occupation

A15 Last Permit Number Date of Issue Expiration Date

DD MM YYYY DD MM YYY
A16 National Health Insurance Number A17 National Insurance Number

A18 Residence Permit Holder  Never Resided

A19 Permit Number Date of Issue Expiration Date

DD MM YYYY DD MM YYY

A20 Endorsed on  Work Permit  Residence Permit  PRC  Never Endorsed

A21 Name of Permit Holder Relationship to you

A22 Permit Number Date of Issue Expiration Date

DD MM YYYY DD MM YYY

A23  Visitor  Never Visited

A24 In which country is the prospective employee Last date of Last date of
residing at the time of this application? entry into the departure from the
Turks and Turks and Caicos
Caicos Islands Islands
DD MM YYYY DD MM YYY

A25 Does the prospective employee have a pending arbitration/reconciliation at the Employment
Services Department or Labour Tribuanl case?  Yes  No

SECTION B THE PERSON TO BE EMPLOYED CONTACT INFORMATION

B1 Residential address and contact information in home country.

Telephone Number Email

B2 If the person to be employed is already in the Turks and Caicos Islands, provide TCI contact
information below.

Telephone Number Email

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 5

 B3 Name and address for communication concerning this application.

Family/last name Given/first name

Company Name and address (if applicable)

Telephone Number Email

SECTION C DETAILS FOR SPOUSE OF THE PERSON TO BE EMPLOYED

C1 Name of person (as printed in the Passport):

TITLE:   
Mr. Mrs. Ms. Dr Other (Please specify)

Family/last name
Photo
Given /first names

C2 Other names you are known by or have ever been known by

C3 ate of Birth: D D M Y Y Y Y C4 Sex/Gender: □ Male □ Female

C5. Country of Birth (including province/state):

C6. Country of Citizenship (if more than 1, list all):(1) (2)

C7. Race/Ethnicity: C8 . Languages spoken: ,

C9. Occupation C10.Present country of residence

C11 Details of all passports held. You are require to give all information as printed in each passport

PASSPORT 1 Passport 2 Passport 3

Country of Issue
Passport Number
Family Name
First/Given name
Date of Issue DD MM YYYY DD MM YYYY DD MM YYYY

Expiration Date DD MM YYYY DD MM YYYY DD MM YYYY

Place of Issue
THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 6
You are required to complete each section below regarding the spouse’s present and/or previous
immigration status in the islands.

Immigration details for the spouse of the prospective employee.

Employer Job Title/Occupation

C13 Last Permit Number Date of Issue Expiration Date

DD MM YYYY DD MM YYY
C14 National Health Insurance Number C15 National Insurance Number

C16  RESIDENCE PERMIT HOLDER  Never Resided

C17 Permit Number Date of Issue Expiration Date

DD MM YYYY DD MM YYY

C18 ENDORSED ON  Work Permit  Residence Permit  PRC  Never Endorsed

C19 Name of Permit Holder Relationship to you

C20 Permit Number Date of Issue Expiration Date

DD MM YYYY DD MM YYY

C21  Visitor  Never Visited Last date of entry Last date of departure
into the Turks and from the Turks and
Caicos Islands Caicos Islands
DD MM YYYY DD MM YYY
C22 In which country is the spouse residing at
the time of this application

SECTION D DETAILS FOR DEPENDENT CHILDREN OF THE PERSON TO BE EMPLOYED

DEPENDENT CHILD 1

D1 Name of person (as printed in the Passport): Phot

o
Family/last name

Given /first names

D2 Other names you are known by or have ever been known by

D3 Date of Birth: D D M Y Y Y Y D4 Sex/Gender: □ Male □ Female

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 7

D5. Country of Birth (including province/state):

D6. Country of Citizenship (if more than 1, list all):(1) (2)

D7. Present country of residence

D8. Name of school currently attending.

D9 Details of all passports held. You are require to give all information as printed in each passport

PASSPORT 1 Passport 2 Passport 3

Country of Issue
Passport Number
Family Name
First/Given name
Date of Issue DD MM YYYY DD MM YYYY DD MM YYYY

Expiration Date DD MM YYYY DD MM YYYY DD MM YYYY

Place of Issue

D10 If this child is residing in the Turks and Caicos Islands what is his/her current immigration status?

D11 Endorsed on  Work Permit  Residence Permit  Never Endorsed

D12  Visitor  Never Visited

Last date of entry into the Turks and Caicos Islands Last date of departure from the
DD MM YYYY Turks and Caicos Islands DD MM YYY
D13 Are you seeking an endorsement for this child?

 Yes  No  No, I intend to do so in a subsequent application.

DEPENDENT CHILD 2

D14 Name of person (as printed in the Passport):

Family/last name

Photo
Given /first names

D15 Other names you are known by or have ever been known by

D16 Date of Birth: D D M Y Y Y Y D17 Sex/Gender: □ Male □ Female

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 8

D18. Country of Birth (including province/state):

D19. Country of Citizenship (if more than 1, list all):(1) (2)

D20.Present country of residence

D21.Name of school currently attending.

22 Details of all passports held. You are require to give all information as printed in each passport
PASSPORT 1 Passport 2 Passport 3
Country of Issue
Passport Number
Family Name
First/Given name
Date of Issue DD MM YYYY DD MM YYYY DD MM YYYY

Expiration Date DD MM YYYY DD MM YYYY DD MM YYYY

Place of Issue

D23 If this child is residing in the Turks and Caicos Islands what is his/her current immigration status?

D24 Endorsed on  Work Permit  Residence Permit  Never Endorsed

D25  Visitor  Never Visited

Last date of entry into the Turks and Last date of departure from the Turks
Caicos Islands DD MM YYYY and Caicos Islands DD MM YYYY

D26 Are you seeking an endorsement for this child ?

 Yes  No  No, I intend to do so in a subsequent application.

D27 Are you separated or divorced from the parent of any of the children in this application?

SECTION E □ Yes □ NoEDUCATION DETAILS FOR THE PERSON TO BE EMPLOYED

If more space is required please attach an additional page.

E1. Last primary school attended

Name of Primary School

Address of School
Country
Date
Date Enrolled DD MM YYYY DD MM YYYY
Completed
□ Graduation  Transfer  Other (please
Reason for leaving
specify:

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 9

 Name of Secondary School

Address of School

Country
Date Enrolled DD MM YYYY Date Completed DD MM YYYY
□ Graduation  Transfer  Other (please
Reason for leaving
specify:

E2.Post-Secondary Education (If you need to provide additional information, please attach an additional
page.)

Name of Institution 1

Address of Institution
Country
DD MM YYYY Date DD MM YYYY
Date Enrolled
Completed
Course Pursued
Certificate/Diploma/Degree □ Associate  Vocational  Bachelor’s  Master’s  Doctorate
Obtained

Name of Institution 2

Address of Institution

Country
DD MM YYYY Date DD MM YYYY
Date Enrolled
Completed
Course Pursued
Certificate/Diploma/Degree □ Associate  Vocational  Bachelor’s  Master’s  Doctorate
Obtained
E3. List ALL Trade or Professional Bodies or Associations with which the person to be employed are
affiliated:

Name of Association
Address of Institution

Country Date of DD MM YYYY

Membership
Name of Association

Address of Institution
Date of
Country DD MM YYYY
Membership

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 10

E5 Give details of ALL disciplinary action to which you have been subject by such Body or Association:

SECTION F CHARACTER DETAILS

F1 For ANY offence, including any driving offence, has the person to be employed, or anyone included in
this application, ever been :

 arrested ?  Yes  No
 charged ?  Yes  No
 convicted?  Yes  No

F2 For ANY offence, in any country, is anyone included in this application currently:

 under investigation?  Yes  No

 wanted for questioning?  Yes  No
 facing charges?  Yes  No

F3 Does anyone included in this application, currently have an outstanding arrest warrant in any country?

□ Yes  No

F4 With respect to any country, including the Turks and Caicos Islands, has anyone included in this
application ever been
 repatriated?  Yes  No
 refused entry?  Yes  No
 removed of deported ?  Yes  No

If your response to any of the above is Yes, provide details below. Insert a new sheet for each person
where required.

Name of Person:

F5 Was the person refused entry, F6 If yes, briefly state the date, the country removed
removed or departed? from and the reason for denial or removal.

□ Yes  No

F7 Was the person arrested? F8 If yes, briefly state the reason/circumstance of the
arrest.
□ Yes  No

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 11

 F9 Was the person charged? F10 If yes, please state the nature of the offence
charged.
□ Yes  No

F11 Was the person convicted? F12 What was the date/s of conviction? DD MM
YYYY

□ Yes  No
DETAILS ABOUT THE CONVICTION

F13 What was the nature of the offence?

F14 What was the date of sentence? DD MM YYYY

F15 What was municipality/city/county

/province/country where convicted

□ Yes  No
F16 Has the sentence been served?

F17 Date sentence completed: DD MM YYYY

□ Yes  No
F18 Is the conviction spent?

SECTION G EMPLOYMENT HISTORY DETAILS

G1 Give the following information regarding your PAST working experience. (Use extra sheets as
needed):
Name of Employer 1
Job Title

Key tasks performed

Country
Date
Date Employment
DD MM YYYY Employment DD MM YYYY
Started
Ended
Reason Employment
Ended

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 12

Name of Employer 2

Job Title

Key tasks performed

Country
DD MM YYYY Date Employment DD MM YYYY
Date Employment Started
Ended
Reason Employment
Ended
Name of Employer 3

Job Title

Key tasks performed

Country
Date Employment
Date Employment Started
DD MM YYYY Ended DD MM YYYY
Reason Employment
Ended
Name of Employer 4
Job Title
Key tasks performed
Country
Date Employment DD MM YYYY
Date Employment Started
DD MM YYYY Ended
Reason Employment
Ended

SECTION H DETAILS ABOUT THE EMPLOYER AND THE JOB OFFERED

H1 Name of Company/Firm/Individual (the Employer)

H2 Company Name and address (if applicable)

H3 Telephone Number H4Email

H5 Fax number

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 13

 H6Name of person to contact regarding information about this application

:
H7If contact person is employed in an Agency, state the Agency’s name and address:

Give the following information about Company/Firm/Individual Employer as applicable:

H8 Business License Number: H9 Business License Category H10 Expiration Date

DD MM YYYY

H11 National Insurance Number: H12 National Health Insurance Number:

H13 Foreign worker’s employment status in the company/firm if given a work permit (tick as
appropriate):

□ Employee (including trainee or intern)  Partner Sole

Proprietor  Director
□ Shareholder
□ Other
(please specify)

H14Foreign worker’s occupation/job title if given a work permit:

H15 Foreign Worker’s main duties if given a work permit:

H16. How many days per month will the Foreign Worker be needed to work if given a Work Permit?

H17 State the duration of the Work Permit sought:

Provide the following information on foreign worker’s remuneration package if given a work permit:

H18. Basic Salary $

□ weekly  biweekly  monthly

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 14

H19. Housing Allowance $ H20Telephone Allowance $

H21Transport Allowance $ H22. Education Allowance$

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 15

H23Other Allowances (specify) $

H24. If the foreign worker’s remuneration package includes a bonus program, say how bonus will be
calculated:

H25. List the names and qualifications of every Turks and Caicos Islander who applied for the position
being offered to the foreign worker (use extra sheet(s) as required :

Name of TCIslander #1

Contact Information Tel: Email:

Qualifications

Reason why he/she are

unable to be hired

Name of TCIslander #2 Tel:

Contact Information Tel: Email:

Qualifications

Reason why he/she are

unable to be hired

Name of TCIslander #3 Tel:

Contact Information Tel: Email:

Qualifications

Reason why he/she are

unable to be hired

Name of TCIslander #4 Tel:

Contact Information Tel: Email:

Qualifications
Reason why he/she are
unable to be hired

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 16

 SECTION I TO BE COMPLETED BY THE PERSON TO BE SELF EMPLOYED AND DETAILS
ABOUT YOUR BUSINESS/COMPANY

I1 Please provide a brief description of the business, for example, who are the customers, what
products/services it sells, how many Turks and Caicos Islanders are likely to be employed. Attach
an additional page if more space is required.

I 2 Name of Business/Company/Firm

I3 Business/Company/Firm’s address

I4 Telephone Number I6 Fax I5 Email

I 7Name of person to contact regarding information about this application

I8 If contact person is employed in an Agency, state the Agency’s name and address:

Give the following information about Company/Firm/Person to be Self Employed as applicable:

I 9 Business License Number: I 10 Business License Category I 11 Expiration Date

DD MM YYYY

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 17

 I National Insurance Number: I 13 National Health Insurance Number:

I 14 Foreign worker’s (the person to be self- employed) employment status in the company/firm if
given a work permit (tick as appropriate):

□ Employee (including trainee or intern)

□ Partner
□ Sole Proprietor
□ Director
□ Shareholder
□ Other (please
specify)

I 15 Foreign worker’s (the person to be self- employed) occupation/job title if given a work
permit:

I 16 Foreign Worker’s main duties if given a work permit:

I 17. How many days per month will the Foreign Worker be needed to work if given a Work Permit?

I 18 State the duration of the Work Permit sought:

Provide the following information on foreign worker’s remuneration package if given a work permit:

I 19. Basic Salary $

□ weekly  biweekly  monthly

I 20. Housing Allowance $ I 21Telephone Allowance $

I 22Transport Allowance $ I 23. Education Allowance $

I 23Other Allowances (specify) $

I 24. If the foreign worker’s remuneration package includes a bonus program, say how bonus will be
calculated:

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 18

 SECTION J DECLARATIONS

J1 Declaration by Employer (Company/Firm/Individual):

I hereby declare that I am authorized to bind the Employer for the foreign worker named in Section A to the
following:

I have read and I understand the applicable regulatory conditions of the grant of a Work permit, as specified in the
Immigration Ordinance 2015.

The Employer consents, for the purpose of assessing this application, for the Government of the Turks and Caicos
Islands and any statutory authorities thereof to obtain from and verify information with any person, organization, or
any other source; and further, to the release of all information thereby obtained to the Government of Turks and
Caicos Islands, Statutory Authorities and authorized agents thereof.

The information as set out in this applicationare, to the best of my knowledge, true and correct; and that all
documents submitted in support of this application are true and authentic copies of the original document.

I understand that it is an offence to provide false or misleading information under Section 97 of the Immigration
Ordinance 2015 and that if found guilty, I am liable on summary conviction to a fine of $20,000 or a term of
imprisonment of four years, or to both.

Name and Designation of Authorized Representative Date: DD MM YYYY

J2 Declaration by an Agency:

(Applicable if the Employer engage the services of an Agency/Agent)

I hereby declare that I am authorized to bind the Employer for the Foreign Worker named in Section A to the
following:

I, the undersigned, am the Agency personnel handling this application.

I have explained the contents of the application and the applicable regulatory conditions of the grant of a Work
permit, as specified in the Immigration Ordinance 2015 to the Foreign Employee and the Authorized Officer of the
Employer.

The information as set out in this application are, to the best of my knowledge, true and correct; and that all
documents submitted in support of this application are true and authentic copies of the original document.

I understand that it is an offence to provide false or misleading information under Section 97 of the Immigration
Ordinance 2015 and that if found guilty, I am liable on summary conviction to a fine of $20,000 or a term of
imprisonment of four years, or to both.

Name, Signature and Designation of Authorized Agency Personnel

Date: DD MM YYYY
Authorized Agency Personnel Contact Details

THIS DOCUMENT IS NOT TO BE SOLD OR PURCHASED 19