Application

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1. Vacancy Applied For

Vacancy/Post

Vacancy No:

State Corporation

2. Personal Details of the Applicant

Title

Surname

First Names

Other Name(s)

Gender

Date of Birth

ID No

Pin.No

Nationality

Ethnicity

Home County

Sub County

Constituency

Postal Address

Code

Town/City

Telephone

Mobile

Alternative Contact Person

Alternative Contact Person Telephone

Are you living with a disability?
YesNo

(i) Details/Nature of Disability:

(ii) Details of Registration with the National Council for People with Disabilities (Registration No. and date

3. Applicants in the Public Service only

Ministry/State Department/County/Other Public Institutions

Station

Personal/Employment No

Present Substantive Post

Job group/Scale/Grade

Date of Current Appointment

Upgraded post

Effective date of previous appointment

On Secondment (where applicable)

Organization

Designation

Job Group/Grade

Please specify

4. All other Applicants

Current employer (where applicable)

Position held

Effective date

Gross Salary (monthly) Ksh

5. Other Personal Details

Have you ever been convicted of any criminal offence or a subject of probation order?
YesNo

If Yes, state nature of offence, the year and duration of conviction

Have you ever been dismissed or otherwise removed from employment?
YesNo

If Yes, State reason (s) for dismissal/removal

Effective Date

(Declaring the above information will not necessarily debar an applicant from employment in the Board. Each case will be considered on its own merit)

6. Academic Qualifications. (Starting with the Highest)

Year		University/ High School	Award/Attainment (e.g. Masters, Bachelors, Degree, KCSE)	Award/Attainment (e.g. Higher Diploma, Diploma, Certificate)	Specialization/Subject (e. g Human Resource, Engineering, Counsellin e.t.c)	Class/Grade
From	To

7. Professional/Technical Qualifications/Certifications Relevant to the post. (Starting with the Highest)

Year		Institution	Course/Programme (e.g. PhD, MSc, BA, O’Level)	Specialization/Subject (e. g Econ, Maths, Sociology e.t.c)	Class/Grade
From	To

8. Relevant Courses and Training attended lasting not less than One (1) Week.

Year	University/College/Institution	Name of Course	Details and duration

9. Current Registration/Membership to Professional Bodies

Professional Body	Membership/Registration No.	Membership type (e.g. Associate, Full etc.)	Date of Renewal

10. Employment Details - where applicable (starting with the current or most recent)

Year		Designation/ Position	Job Group/Grade/ScaleGross Monthly Salary(Ksh)	Ministry/State Department/ Institution/ Organization
From	To

11. Briefly state your current duties, responsibilities and assignments (if any)

12. Please give details of your abilities, skills and experience which you consider relevant to the position applied for. This information may include an outline of your most recent achievements and your reasons for applying for this post.

13. Referees (People who have interacted with you professionally)

Referee 1

Full Name

Occupation

Address

Post Code

City/Town

Mobile No

Period for which the referee has known you

Referee 2

Full Name

Occupation

Address

Post Code

City/Town

Mobile No

Period for which the referee has known you

Referee 3

Full Name

Occupation

Address

Post Code

City/Town

Mobile No

Period for which the referee has known you