W2

WORK PERMIT BOARD

APPLICATION FOR THE GRANT OF A WORK PERMIT

An application for a work permit should be addressed to:
The Director of WORC, P.O. Box 1098, Grand Cayman KY1-1102, CAYMAN ISLANDS. (for Grand Cayman Applications)
OR
The Secretary to the Work Permit Board, P.O. Box 1098, Grand Cayman KY1-1102, CAYMAN ISLANDS. (for Grand Cayman Applications)
OR
The Secretary to the Cayman Brac and Little Cayman Immigration Board, Government Administration Building,
P.O. Box 240, Cayman Brac KY2-2101, Cayman Islands. (for Cayman Brac and Little Cayman Applications)
PLEASE DO NOT LEAVE ANY QUESTION BLANK. IF A QUESTION DOES NOT APPLY TO YOU, INSERT “NOT APPLICABLE” OR “N/A” IN THE SPACE PROVIDED.
NOTES: (i) Refer to the checklist accompanying this form for additional documents required to process this application. (ii) Use separate sheet of paper,
where necessary, to thoroughly answer each question. (iii) If the employer / additional employer is a company; all communication will be sent to the contact information associated
with the company's Trade & Business License as held by the Department of Commerce and Investment.

APPLICATION FORM CONTAINS 11 PAGES

PART 1 - To Be Completed By the Prospective Employee
DO NOT USE LIQUID PAPER OR CORRECTION TAPE, IF AN ERROR IS MADE CROSS OUT AND INITIAL THE CHANGE(S) OR USE A FRESH PAGE

1. File Number (if known) (Also known as "Work Reference Number")

2. Surname (Last Name) Maiden Name Given Names (First Names)

3. Nationality Date of Birth D/MMM/YY Gender: Male Female

4. Passport number Date of Issue D/MMM/YY Place of Issue Date of Expiry D/MMM/YY

5. Any other Names known by Personal Email Address:

6. Address:

District: P.O. Box and KY: Telephone:

7. What is your marital status? (certified copy of relevant legal document should be attached, where applicable)

Single Married Divorced Separated Civil Partnership Dissolved Civil Partnership

Name and nationality of spouse/civil partner

8. (i). What date did you first arrive in the Cayman Islands? Date: D/MMM/YY

(ii). What date did your first employment in the Cayman Islands begin? Date: D/MMM/YY
(iii). Was this employment authorised by: (a) A Work Permit
(b) A Government Contract
(c) Other form of Authorisation (For example, were you exempted from work permit requirements under the Immigration
Law or any previous immigration legislation?) Please explain.

(iv). Since your first arrival in the Cayman Islands have you ever been named as a dependant on another person's work permit/government contract/exemption?

Yes No If you answered yes, please provide name of permit holder:

WORC/WPG (2021/10) W2 Page 1 of 11

 WORK PERMIT BOARD

Application For The Grant Of A Work Permit

(v). Since your first arrival have you at any time left the Cayman Islands for a period in excess of one year? Yes No

If yes, please give dates of and reasons for the absence:

9. Dates and addresses of all places where you have lived for more than 6 months during the past 10 years, if other than stated in reply to question 6. This is to include places lived
prior to arriving in the Islands.

From To Address

D/MMM/YY D/MMM/YY

D/MMM/YY D/MMM/YY

D/MMM/YY D/MMM/YY
10. What is your level of education? (Certified copies of certification must be attached)
Less than High School/Secondary School High School/Secondary School Post-Graduate Degree (Diploma, Master's, Ph.D.)
Sixth form Associate Degree Professional Qualification (e.g CPA, CA, ACCA, ACIS,
Technical/Vocational Bachelor's Degree CFA, ACIB, AICB, MRICS, City & Guilds, NVQ etc.). List
all that apply:

11. What position are you applying for?

12. How many years and what experience do you have which is relevant to this job?

13. Are you of Caymanian descent or have close connections with the Cayman Islands, either historically, or by marriage to a Caymanian? Yes No
If yes, please provide details and include marriage and/or birth certificates

Name Relationship Address

14. Do you have any dependants? If yes, please list particulars below: Yes No
Name Date of Birth Nationality Relationship Country of Residence Add to Work Permit

D/MMM/YY Yes No

D/MMM/YY Yes No

D/MMM/YY Yes No

D/MMM/YY Yes No

D/MMM/YY Yes No

WORC/WPG (2021/10) W2 Page 2 of 11

 WORK PERMIT BOARD

Application For The Grant Of A Work Permit

15. (i). Have you ever been charged or convicted of a criminal offence in any country Yes No If you answered yes, please give details
(including the Cayman Islands)?

Nature of offence Date Location Verdict and Sentence

DD/MM/YY
DD/MM/YY
(ii). Have you ever been required to pay an administrative fine for an offence in the Cayman Islands or other country, other than for a traffic offence? Yes No
If you answered yes, please provide details.

Nature of fine Date Location Amount (CI$)

DD/MM/YY

DD/MM/YY
(iii). Have you ever been sanctioned by a professional ethics body, licensing board or any other regulating body? Yes No
If you answered yes, please provide details.

Nature of sanction Date Location Reasons

DD/MM/YY

DD/MM/YY
(iv). Have you ever been deported from or refused entry to:
(a) the Cayman Islands Yes No If you answered yes, please give details

(b) any other Country Yes No If you answered yes, please give details

16. Have you ever been bankrupt or owned shares, equity or rights in a non-public quoted company or been a director, manager, or officer of a company, partnership or entity which
went bankrupt or ceased trading without creditors being paid in full? Yes No If you answered yes, please provide dates and details in your cover letter.

17. Are you solvent? (Are you able to pay all debts/bills as they become due?) Yes No If no, please explain.

18. Have you ever been actively involved in politics in or outside the Cayman Islands? Yes No
If you answered yes, please give dates and details:

19. Have you ever had a permit to work refused, revoked or not renewed upon application in any country during the past 15 years? Yes No

If yes, when, where and for what reasons?

20. Are you, and all dependants accompanying you, in good physical and mental health? Yes No
If no, please give details:

WORC/WPG (2021/10) W2 Page 3 of 11

 WORK PERMIT BOARD

Application For The Grant Of A Work Permit

Important note: Applicants from a non-English speaking country must have their English language skills tested. The applicant must receive a passing mark on their assessment to
take up employment in the Cayman Islands.

21. Is English your native language? Yes No

If No, what is your native language? and answer all other language related questions.

Do you speak English? Yes No

Do you read English? Yes No
Do you write English? Yes No

Are you currently on Island? Yes No

Have your English skills been previously tested by?

Score/Band Score Report No Exam Date

a) IELTS Yes No D/MMM/YY Attach a copy of your score report
b) TOEIC Yes No D/MMM/YY Attach a copy of your score report

DECLARATION
I declare the information contained in this application to be correct to the best of my knowledge and belief and I am aware that it is a criminal offence to make a
statement or representation that is false in a material fact which I know to be false or do not believe to be true.

In accordance with Section 56(4)(b) of The Immigration (Transition) Act, 2021, I hereby agree to submit to being Fingerprinted/Palm-printed for the purpose of identity verification and
criminal checks domestically and internationally.

Print Employee Name Signature of prospective worker Date (dd/mmm/yyyy)

WORC/WPG (2021/10) W2 Page 4 of 11

 WORK PERMIT BOARD

Application For The Grant Of A Work Permit

NOTES: (i) Refer to the checklist accompanying this form for additional documents required to process this application. (ii) Use separate sheet of paper, where necessary, to
thoroughly answer each question.

PART 2 - To Be Completed By the Employer DO NOT USE LIQUID PAPER OR CORRECTION TAPE, IF AN ERROR IS MADE CROSS OUT AND INITIAL THE CHANGE(S) OR
USE A FRESH PAGE

1. Name of employer or employing company

Trade name (if different from above)

2. Date of Birth (if primary employer is a person) D/MMM/YY

3. Is Permit to be shared? Yes No If Yes, Name of additional employer

Phone of additional employer e-Mail of additional employer

Is additional employer a person? Yes No If Yes, provide Date of Birth D/MMM/YY

If Yes, also provide Employer of additional personal employer

3. a. Position to be filled with additional employer.

3. b. How much will the employee receive in salary or wages from additional employer? CI$ US$ hour day week month

3. c. How many hours is the worker required to work each week with additional employer?

4. Postal Address & KY

5. Telephone (Work) Telephone (Home) Email Address

6. Nature of business or occupation of employer

Name of your employer Employer's Address

7. State under which law business is licensed to operate

Expiry date of current licence D/MMM/YY Licence number

8. Position being filled (by prospective employee)

9. Is this applicant replacing an employee? Yes No If yes, provide name and nationality of person being replaced:

10. Has this job been registered on the JobsCayman portal? If yes, please provide the Job ID. Yes No Job ID:

11. i. Has the job been advertised locally or overseas in a written or online newspaper or other media? If yes, please provide copies of the advertisements. Yes No

ii. If the job was advertised locally or overseas, did a Caymanian or Permanent Resident apply? Yes No

If Yes, how many applied and why were none hired?

12. How many people do you currently employ? Of those you employ, how many are Caymanian? How many are Permanent Residents?

WORC/WPG (2021/10) W2 Page 5 of 11

 WORK PERMIT BOARD

Application For The Grant Of A Work Permit

13. If you employ Work Permit Holders, provide nationality and the number of persons (Use separate sheet if necessary):-
Nationality Number of Persons Nationality Number of Persons

14. Do you operate a training programme? Yes No If you do, please provide details of it with particular reference to how it will equip Caymanians with the skills
and experience to do the job (Use separate sheet of paper,if necessary)

15. Do you offer a scholarship program? Yes No If so, please provide details of your scholarship process and how it will be beneficial to Caymanians.

16. Why hasn't a Caymanian been found from within your own work force to do the job?

17. (i). How much will the worker receive in salary or wages? CI$ US$ hour day week month
(ii). How many hours is the worker required to work each week?
(iii). What other benefits, (if any) will the worker receive?

(iv). If worker is a household domestic, will the worker live in the same residence as the employer? Yes No
(v). If worker will receive gratuities, does the employer have a gratuities scheme in place approved in writing by the Director of Labour? Yes No
(If yes, please provide copy of Approval)

18. (i). If shared, how much will the employee receive in salary or wages from the additional employer? CI$ US$ hour day
week month
(ii). How many hours is the worker required to work each week for additional employer (if applicable)?
(iii). What other benefits, (if any) will the worker receive from additional employer (if applicable)?

19. For what period is the permit required 1 year 2 years 3 years 4 years 5 years (ii) What is the proposed start date?
*Under the Immigration (Transition) Act, domestic helpers, teachers, doctors, nurses and ministers of religion may be granted a work permit for a period of up to 5 years.

20. I am requesting that the approval coincides with my spouse's work permit, per section 66(10) of the Immigration (Transition) Act, 2021. Yes No

DECLARATION
I declare the information contained in this application to be correct to the best of my knowledge and belief and I am aware that it is a criminal offence to make a
statement or representation that is false in a material fact which I know to be false or do not believe to be true.

Signature of Employer Date (dd/mmm/yyyy)

Signature of Additional Employer Date (dd/mmm/yyyy)

WORC/WPG (2021/10) W2 Page 6 of 11
 WORK PERMIT PAYMENT LOG

Employer

Employee

Occupation

Number of Accompanying Dependants:

WORK PERMIT FEE (for first year only) CI$

ADMINISTRATION FILING FEE CI$

DEPENDANT'S FEE CI$

REPATRIATION FEE (Non-refundable one-time payment per person) CI$

TOTAL FUNDS SUBMITTED CI$

PAYMENT METHOD: CASH / CHEQUE

CHEQUE NUMBER

WORC/PL (2020/06) PL001 Page 7 of 11

 Health Insurance and Pension - Supplement To Work Permit Application
(Temp/Grant/Renewal)

Questions relating to the Provision of Pension Benefits and Health Insurance

DO NOT USE LIQUID PAPER OR CORRECTION TAPE, IF AN ERROR

Supplement - To Be Completed By Employer and Attested To By The Employee IS MADE CROSS OUT AND INITIAL THE CHANGE(S) OR USE A FRESH
In accordance with the National Pensions Law after an employee has completed 9 months of PAGE
PENSION PLAN employment in the Cayman Islands, the enrollment & payment of pension contributions are mandatory.

1. Do you have a valid Pension Plan for this employee in accordance with the National Pensions Law and its current revisions? Yes No

If No, please explain:

2. What is the name of the Company and Administrator of your registered Pension Plan?

Company Telephone No

E-Mail Address Employee Pension No

Registration No

3. Are your Company's Pension Plan contributions for this employee paid up to date? Yes No

If No, please explain:

HEALTH INSURANCE In accordance with the Health Insurance Law every person, and their dependants, resident on Island must have health insurance coverage effected by their employer.

1. Do you have a valid Health Insurance Plan for this employee in accordance with the Health Insurance Law and its revisions and regulations thereunder? Yes No

If No, please explain:

2. What is the name of the Company and Administrator of your registered Health Insurance Plan?

Company Telephone No

E-Mail Address Employee Membership No

Policy No

3. Are your health insurance premiums for this employee paid up to date? Yes No

If No, please explain:

EMPLOYER'S DECLARATION: EMPLOYEE'S DECLARATION:

I declare that the information given above is correct and confirm that the employee for whom the work permit is being I declare that the information given above is correct and confirm that the employer from which I seek
sought is or will become a member of the above Health Insurance Plan in accordance with the Health Insurance Law employment has or will enrol me in the Health Insurance Plan and has or will enrol me in the above Pension
and is a member or will join the above Pensions Plan in accordance with the National Pensions Law. Plan (unless exempted by Pensions Law).

I understand that I will be responsible for any medical expenses incurred by the employee and their dependants in the I understand making a false statement or representation knowing the same to be false in accordance with the
absence of a standard health insurance contract. Immigration (Transition) Act, I am liable on conviction to a fine of up to CI $5,000.00 and imprisonment of one
year.
I understand making a false statement or representation knowing the same to be false in accordance with the
Immigration (Transition) Act, I am liable on conviction to a fine of up to CI $5,000.00 and imprisonment of one year.

Name of Employer Name of Employee

Authorized signatory for Signature
and on behalf of Employer Cannot be Agency signature Cannot be Agency signature

Print Name Date (DD/MMM/YY)

Date (DD/MMM/YY)

WORC/H&P (2021/04) HP001 www.worc.ky Page 8 of 11

 AC001

Accommodation Supplement

It is a Government requirement that suitable accommodation must be available for the employee and for any dependants. DO NOT USE LIQUID PAPER OR CORRECTION TAPE, IF AN ERROR IS
Accordingly, this form must be completed in full by the Employer, attested to by the Employee and Landlord/Rental Agent, and MADE CROSS OUT AND INITIAL THE CHANGE(S) OR USE A FRESH PAGE
submitted along with the Work Permit Application Form.

1. Is the prospective Employee on Island? Yes No If No, move to question 9.

2. Employee's Physical Address

District PO Box and KY Telephone

Block and Parcel No -

3. Type of Building Dwelling House Apartment Hotel

4. How many rooms are available for the employee and his/her family?

Bedrooms Bathrooms Living Rooms Kitchens

5. Will any of these rooms be shared with other occupants of the dwelling? Yes No If Yes, give details - including number of other occupants and which rooms

6. This accommodation is Owned by the Employer Owned by the Employee Rented by the Employer Rented by the Employee

7. If Rented, what is the period of lease?

8. If Rented, the name and address of the Landlord/Rental Agency is

(i) House No (ii) Street Name

(iii) District (iv) PO Box and KY (v) Telephone

9. When the Employee arrives on Island, to work, please advise on their proposed accommodation:
Physical Address:

I understand and agree that a representative of the Department of WORC may be required to view the premises described above at any reasonable hour of the day.
I declare that the information provided above by me is true and correct and I understand and accept that if it is proven that I have made a false statement, I am liable on conviction
to a fine of CI $5,000 and imprisonment for one year.

Print Landlord Name Landlord Signature Date (dd/mmm/yyyy)

Print Employee Name Primary Employee Signature Date (dd/mmm/yyyy)

Print Primary Employer Name Primary Employer Signature Date (dd/mmm/yyyy)

WORC/ACC (2021/10) AC001 www.worc.ky Page 9 of 11

 PC001

PHOTOGRAPH TEMPLATE
Applicants Only

Surname (Last Names) Given Names (First Names) Maiden Name (if applicable)

File Number (if known) (Also known as "Work Reference Number") Application Date D/MMM/YY Date of Birth D/MMM/YY

Applicant Full Face Photo

Maximum Size

Minimum Size

Full Face Photograph

Do Not Use Staples!

Photographs may be taped or glued to the picture diagrams.
Instructions:
• For Work Permit Grant, Work Permit Renewal, Permanent Residency and Cayman Status applications, provide Full Face Photo (1 photo).
• Print Last Name, First Name(s), and Date of Birth on the back of photograph.
• The photograph must:
• be a "passport type" photograph
• be in colour
• be taken within the past 12 months
• show full face (shoulders and above)
• have no head covering
• have a plain white background
• be between 45mm by 35mm (1.77 inches by 1.38 inches) and 63mm by 50mm (2.5 inches by 2 inches), see diagram below
• be unmounted
• be printed on normal photographic paper
• if digital, have resolution of at least 800 dpi (dots per inch)
• Blurred photographs will not be accepted.
• Stick-on labels will not be accepted.

WORC/PHPG (2020/08) PC001 www.worc.ky Page 10 of 11

 WORK PERMIT BOARD - WORK PERMIT GRANT CHECKLIST
This list is a summary of general requirements for ALL applicants. The Department of WORC reserves the right to request additional information or documentation as it sees fit.

Application forms duly completed, signed and dated by employee and employer. Please do not leave any question blank. If a question does not apply to you, insert
"not applicable" or "n/a" in the space provided.
Cover letter(s) signed by Employer and Additional Employer (if applicable) with detailed summary of why the work permit is required.

Correct work permit fee, including non-refundable CI$100 application fee, dependant fee if applicable, and non-refundable CI$200 repatriation fee for each person.
A full page copy of newspaper advertisements (if advertised in a local or overseas newspaper)- with visible dates, including salary range and all other benefits.
Resume of all Caymanian applicants including JobsCayman referrals and self-referrals explaining why they were not hired for the position.
Certified copies of newly acquired educational certificate/diplomas/degrees.
Original signed and sealed, Police Clearance certificate - less than 6 months old

Original medical declaration cover letter - may be no older than one year old at date of submission

1 full face passport sized photograph (See online guidelines) Cuban Nationals provide certified copy of Cuban Visa
A copy of the T&B License, where the Trade & Business License has expired, a copy of the receipt of payment for the renewal from employer
Where the employer is licensed by another body other than the Trade & Business Licensing Board, proof of current license or copy of the receipt of payment for the renewal

FOR ACCOMPANYING DEPENDANTS (First Time Adding)

Child(ren): 17 years and under: 1) a certified birth certificate
2) a letter from a private school confirming acceptance/attendance.

Child(ren): 18 years and older: 1) An original medical declaration cover letter (less than 1 year old)
2) certified birth certificate
3) original signed and sealed Police Clearance certificate (less than six months old, from last place of residence)
4) letter from school confirming acceptance/attendance (required annually).

Spouse/Civil Partner: 1) An original medical declaration cover letter (less than 1 year old)
2) certified copy of marriage/civil partnership certificate
3) original signed and sealed Police Clearance certificate (less than six months old, from last place of residence)
4) Affidavit (AF66-10) to be completed if applying under Section 66(10)

ADDITIONAL REQUIREMENTS BY INDUSTRY

Construction: Copy of WORC Form A (or a list of clients including addresses and telephone
numbers) AND copies of signed contracts, from employer, redacted where appropriate. Janitorial or Gardening: Copy of WORC Form A (or a list of clients including addresses and
A customized version of From A can be provided by companies who have more than 15 telephone numbers)
contracts, however each page must have declaration on it and be signed and dated.
Electrical: Certified copy of license from Electrical Board of Examiners and the ratio of If regulated by CIMA: Written approval for Senior Finance/Banking professional
Electricians to apprentice/wiremen (e.g. Managing Director, CEO)
Nurse/ Health Practitioner: Approval from Health Practitioner's Board Veterinary: Approval from Veterinary Board
Caretaker for the elderly or infirm: A Physicians letter confirming the illness if under 65 years Driver: Certified copy of of license from the Public Transport Board for the appropriate
of age (proof of age is required) category of vehicle
Security Officer: Copy of license from the Royal Cayman Islands Police (RCIP) Mobile Car Wash: Copy of Mobile Car Wash Vehicles' Logbook(s) and Insurance Certificate(s)

Plumbing: Certified copy of license Employment Agency: Proof of past and future employment for the applicant
Domestic, nanny or caretaker: Certified copies of birth certificates of children to be cared
Farming: Certified copy of certification from the Department of Agriculture
for.
Diving: Certified copy of PADI/NAVI qualifications

WORC/CKL (2023/06) CKLW2 Page 11 of 11