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Form LAB/EW/1 FEDERAL REPUBLIC OF NIGERIA LABOUR ACT CAP Li LFN 2004 (SECTIONS 23, 24, 25 and 71) FEDERAL MINISTRY OF LABOUR AND PRODUCTIVITY For Official Use Only 1, State. 2. Date Received. APPLICATION FOR EMPLOYER'S PERMIT/ RECRUITER'S LICENCE 3. Checked. PRIVATE EMPLOYMENT AGENCY 4. Certificate No. 5. Treasury Receipt No I/We hereby apply for registration and issuance of Employer's Permit/Recruiter’s Licence ("Delete whichever is not applicable) PART A 1 Name of Applicant... Serena 2. Registered office: a. Postal Address: b. Location AddPeSS! arn Telephone No(s) d. E-mail Address... e. Website Address 3. Head Office: a. postal Address: b. Location Address: Telephone No(s } d. E-mail Address: wunw.nelexnigeria.com 1 10. 11, 12. 13. 14. 15. e. Website Address: Do you have Branch of fices? If yes, attach list. Attach Names, Addresses and Mobil/Cell Telephone Numbers of Directors Attach copy of the Management Profile. Are you an Employer or a Recruiting Agent. Tf Recruiting Agent, are you an *Employment Agency or a *Labour Contractor If Labour Contractor or Employment Agency, indicate the sector{sf* you wish to be registered [maximum of 5 Juss: If recruitment is for Oil and Gas, Construction, Manufacturing or Security Sector, please attach copy(ies) of Regulatory/Professional Certificate. Tf Labour Contractor, give the name(s) of your major client(s), [if any}. What categories of workers do you wish to recruit? [Skilled] [Semi-skilled] or [Unskilled] - Tick whichever is applicable. Do you have a training policy? Provide details....0.10 a. Has any of your Directors ever been convicted under the Nigerian Law?, : ie b. If yes, what was the offence, and when?, a. Are you recruiting for another person(s) or organization(s)? www.nelexnigeria.com 2 b. Tf yes, is/are that/those person(s) or organization(s) in possession of a valid permit? [Attach contract agreement between the recruiter and organization] Are you recruiting person(s) under the age of 16 years?...u..nssnsssnnnansne Will you ensure that the worker(s) is/are not recruited by illegal pressure, misrepresentation or mistake?...... What other documents are you submitting in support of this application? Please list. [co] Are your workers unionized)... [b] If Yes, give name{s] of their Union{s]/Association{s] 20. (A) Are you in position to deposit Bank/Insurance security with the Ministry for the following: [i] Unpaid salaries and wages of workers to be recruited? [ii] Differed wages which are duly authorised by the Honourable Minister? [iii] Other contingencies? (8) If Yes, state type and value of security... wunw.nelexnigeria.com 3