COMPLETION OF EMPLOYMENT APPLICATION

Please find attached our Employment Application form for you to complete. Please submit
a recent full face (Passport sized or 8x10) photo with your application.

In filling out the form, please take note of the following:

1. Read the application fully, including any special instructions.

2. Print clearly.
3. It is very important to fill out the form appropriately, accurately, truthfully &
completely.
4. Answer all questions on the form. When something doesn’t apply to you, write N/A for
Not Applicable. When the correct answer would be None, write None.
5. Please read carefully and take note of the statement on the form which is located
above your signature at the end of the application form.
6. In order for your application to be complete and considered, it must be submitted with
a valid Cayman Islands Police Record. If you are not residing in the Cayman Islands &/or
require a work permit for gainful employment you do not need to submit a police
record at this time.
7. A copy of proof of citizenship must accompany this application.

We anticipate your kind and prompt completion and return of same to us within ten (10)
days so we can proceed with your application.

Regards,

ASSOCIATED INDUSTRIES, LTD

T: 345.949.7539 | E: [email protected] | 17 Lancaster Crescent, George Town

P O Box 10747, Grand Cayman KY1-1007, CAYMAN ISLANDS
 Updated 5/7/2019

17 Lancaster Crescent, George Town, Grand Cayman | T: (345) 946-7539 | E: [email protected]

CONFIDENTIAL

EMPLOYMENT APPLICATION FORM

PLEASE PRINT CLEARLY

IT IS IMPORTANT THAT YOU COMPLETE THIS APPLICATION FULLY AND TRUTHFULLY. PLEASE NOTE THAT FAILURE TO
DISCLOSE RELEVANT DETAILS OR GIVING MISLEADING INFORMATION WILL CAUSE YOUR APPLICATION TO BE REJECTED OR
IF YOU ARE APPOINTED IT COULD LEAD TO TERMINATION OF CONTRACT.

Section 1: Personal Details

Name: RAFAEL II
Age:
OBUSAN
R 35
Last First Middle Initial

N/A
Maiden Name: 16/09/1983
Date of Birth: Sex: M F

Physical Address: 402 CAMAGONG ST., HAPPY HOMES, TAGAS, TABACO CITY, ALBAY, PHILIPPINES

How long have you lived at the above address?

11 YEARS

Mailing Address: 402 CAMAGONG ST., HAPPY HOMES, TAGAS, TABACO CITY, ALBAY, PHILIPPINES
N/A
Home Phone: Cell +639175935125
Phone: Email: [email protected]

LA PLAYA VILL., BONOT, LEGAZPI CITY, ALBAY, PHILIPPINES

Previous Address: How long did you live there?
15 YEARS

Are you a Caymanian? Yes No If not a Caymanian, what nationality are you? FILIPINO

Do you have Caymanian Status? Yes No If yes, please provide proof.

Do you have Permanent Residency in Cayman with the Right to Work? Yes No If Yes, please provide proof.

Do you have any Cayman connection? Yes No If Yes, state: FORMER COLLEAGUES WORKING AT CAYMAN

Marital Status: Single Engaged Married Separated Divorced Widowed

If married, date of marriage:

08/04/2008 Name of Spouse: KATRINA-CHAZY A. OBUSAN
(Day / Month / Year)

FILIPINO
Nationality of spouse: Is spouse employed? Yes No Kind of work:

If Spouse is Employed, name of employer:

N/A

Number of dependents: 3 Number of children: 2 Ages of children:

11 & 4

Do you own your own home? Yes No If not, state: Rent/Stay with friends or family:

Do you want to work: Full time Part time – specify days and hours if part-time:

CONSTRUCTION DIVISION MANAGER

Position applied for: Rate of pay expected $ per
57,600 ANNUM

Have you worked for us before? Yes No If Yes, when?

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Name any friends or relatives working for us and relationship:
N/A Updated 5/7/2019

If hired, what date will you be available to start work?

SEPTEMBER 20, 2019

Do you have any physical handicaps which would prevent you from performing specific kinds of work? Yes No

If yes, explain your limitations

Have you had a serious illness in the past 5 years? Yes No (Describe)

Have you ever received compensation for injuries? Yes No (Describe)

Have you ever been convicted of a crime, or charged? Yes No (Describe)

What languages other than English do you speak fluently? FILIPINO

Read Write

Person to be notified in case of accident or emergency: Name: KATRINA-CHAZY A. OBUSAN

SPOUSE
Relationship: Phone: E-mail:
+639177919570 [email protected]

Address:
402 CAMAGONG ST., HAPPY HOMES, TAGAS, TABACO CITY, ALBAY, PHILIPPINES

NORIETA R. OBUSAN
Mother’s name: Living? Yes No

ARNIE R. OBUSAN
Father’s name: Living? Yes No

Are you hampered by religion or otherwise from normal working hours for this job? Yes No

If Yes, state:

Please give particulars of transportation to and from work and state any problems envisage: DRIVE BY CAR OR MOTORBIKE

How many days have you missed from work (or would have missed) in the past 12 months? And why? 15 DAYS DUE TO FAMILY
BIRTHDAYS AND SPECIAL OCCASIONS

What are your career goals? I WANT TO BE AT A VP OR CEO LEVEL BEFORE I TURN 50.

Do you plan to further your studies? Yes No If Yes, Explain YOU ARE NEVER TOO OLD FOR NEW AND

ADDITIONAL KNOWLEDGE.

What was your reason for leaving (or wanting to leave) your last employment? AN OPPORTUNITY TO WORK OUTSIDE
THE COUNTRY.

How much notice did you give (or you will give) your previous employer? 45 DAYS

Do you have a C.I. Drivers License? Yes No If so, what type(s) Group (s)

How long have you had a valid driver’s license? 17 YEARS

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 Updated 5/7/2019
DO YOU SMOKE/VAPE? Yes No If Yes, can you go a workday without smoking/vaping? Yes No

Do you agree, if employed, to not smoke during working hours and when on Company property or in Company vehicle for each and
every workday during your employment? Yes No

Section 2: Present Employment (If not employed give details of last employer)

Company: CEMEX HOLDINGS PHILIPPINES - APO CEMENT CORPORATION

Address: 34TH FLOOR PETRON MEGAPLAZA, BUENDIA AVE., MAKATI CITY, PHILIPPINES
BUSINESS DEVELOPMENT MANAGER
Job title: Supervisor:
VP - PLANNING & ADMINISTRATION

15/07/2018 - PRESENT
Date of employment: Salary CI$ 21,410
Starting: Ending:
Responsible for creating opportunities in non-core businesses (aggregates, admixtures &
Briefly Describe Duties:

ready-mix). Tasks include Sales, Accounts Management, Quality Control, Customer Complaint Management.

45 DAYS
Period Notice Required Last day of service(if no longer employed)

Reason for leaving (if no longer employed)

Section 3: Work History (Most recent employer first)

Company 1: VIKING CONSTRUCTION AND SUPPLIES

Address: SUDIPEN, LA UNION, PHILIPPINES

OPERATIONS MANAGER
Job title: Supervisor:
OWNER/PROPRIETOR

10/05/2018 - 10/07/2018
Date of employment: Salary CI$ 18,685
(starting): Salary CI$ 18,685
(ending):

Briefly Describe Duties: RESPONSIBLE FOR IMPROVING SALES PERFORMANCE OF THE READY-MIX AND

AGGREGATES BUSINESS. MANAGED DAILY OPERATIONS AND MONITORED FINANCIAL PERFORMANCE

Reason for leaving (if no longer employed) BETTER OPPORTUNITY

Company 2: JRY CONSTRUCTION

UNIT 214 PACIFIC REGENCY TOWER, P. OCAMPO ST., MALATE, MANILA PHILIPPINES
Address:

PROJECT MANAGER
Job title: Supervisor: OWNER/PROPRIETOR

01/01/2018 - 08/05/2018
Date of employment: Salary CI$ 17,440
(starting): Salary (ending): CI$ 17,440

Briefly Describe Duties: MANAGEMENT OF MULTIPLE ON-GOING PROJECTS, QUANTITY TAKE-OFF

AND ESTIMATES, CONSTRUCTION METHODOLOGY AND PROGRAM OF WORKS

Reason for leaving (if no longer employed)

BETTER OPPORTUNITY

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 Updated 5/7/2019
Have you ever been bonded? Yes No If Yes, on what job(s)

Does your present employer know of your plans to change employment? Yes No

May we contact the employers listed in this application form? Yes No

(If not, indicate below which one(s) you do not wish us to contact.)

Section 4: Education

School Name and City How Many Graduated? Course/Major

Years Attended
Grammar DIVINE WORD COLLEGE OF LEGAZPI CITY 6 Yes No N/A
UNIVERSITY OF STO. TOMAS - LEGAZPI CITY
High School (FORMERLY AQUINAS UNIVERSITY) 4 Yes No N/A
College BICOL UNIVERSITY - LEGAZPI CITY 7 Yes No BS in CIVIL ENGINEERING
Other Training UNIVERSITY OF MAKATI - MAKATI CITY 1 Yes No MASTER IN BUSINESS ADMINISTRATION
or Education

Describe any other experience, skills or qualifications which you think are relevant: SALES METHODOLOGY - SANDLER

Section 5: References

Reference 1 Reference 2
Name: JEZZEL ALFONSO M. DE LARA RONALD BAYRON
Position (job title): OPERATIONS MANAGER CONCRETE PLANT MANAGER
Organisation: NATIONAL CEMENT LTD NATIONAL CEMENT LTD
Work Relationship: FORMER SUPERVISOR FORMER COLLEAGUE
Address: GEORGE TOWN, CAYMAN IS. GEORGE TOWN, CAYMAN IS.
Phone Number: +13459293471 +13455161763
Email: [email protected] [email protected]
This referee may be contacted at any Yes No Yes No
stage during the recruitment process
This referee may be contacted only if Yes No Yes No
shortlisted

Section 6: Declaration

I hereby authorize investigation of any and all statements contained in this application. I understand that if employed, false state-
ments on this application shall be sufficient cause for dismissal. I understand and agree that if employed, my employment is for
no definite period. I understand that if employed, there will be a probation period of six months which may be extended by mutual
agreement for an additional six months. I understand that regardless of the date of payment of my wages or salary, my employment
may be terminated during the probation period at any time without prior notice.

25/06/2019
Date: Signature:
(Day / Month / Year)

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