TEACHING SERVICE

TS FORM 3(Rev) Stocked by Min of Education

10m A 498 2188 P/F2

PART 1

LETTER OF APPOINTMENT
Staff Ts No: ………………………...

TO: MR/MRS/MS (BLOCK LETTERS) Surname: …………………………………………………………

Forenames: .……………………………………………………....

1. You are appointed as a …………………in Division One, Two, or Three of

the Zambia Teaching Service with effect from…………………20……………………..
on Probation/Temporarily/as a confirmed employee.
2 Your incremental salary is at the rate of……………. a year in the scale…………………
And your incremental date is………………………………………………………………
3. You are posted to ………………….. school under manager group number………… and
Pay number…………………
4. You are expected, so long as you are in service, to serve the youth of the country to the
best of your ability and up hold the highest standards of teaching profession.
5. If it is found that you are unable to perform effectively the duties of your appointment, or if
You misconduct yourself, you may be discharged at……………………………….notice.
6. You may be dismissed without notice if you repeatedly or seriously misconduct yourself or
if it is found that you are inefficient owing to negligence or idleness.
7 If you wish to resign you must give…………………………………. Notice.
8 You are liable to serve in any part of the country
9 The provisions of the Zambia Teaching Service Regulations and the Zambia Teaching Service
Pensions Regulations apply to you.
10. Special conditions which apply to your appointment in accordance with the provision to
Regulation 4 of the Zambia Teaching Service Regulations are attached.
11. You are expected to pass an efficiency Bar Examination before the …………….20…………..
Failure to pass the examination on by due date will result in the withholding of increments and
may lead to your being discharged from the service.

APPLICATION ONLY TO TEACHERS ON TEMPORARY TERMS OF SERVICE ONLY.

12. In the event of your marriage interfering in any way with the performance of your
Duties the right is reserved to terminate your appointment without notice.
13. Quarters will/will not be provided.

Place of engagement to………………………………………………………………………………..

Date: ………………………………Signed: ………………………………………………………..
For Permanent Secretary, Ministry of Education
* Delete if not applicable
 PART II

Marital Status: Married/Single/Married women…………………………………………………………

National Registration No and Date of Birth: ………………………………………………………
Qualifications: ……………………………………………………………………………………
College at which trained: …………………………………………………………………………
Please insert in the below any payments made locally.

Date of payment Amount

K N

Total

Certified correct: ……………………………………………………………………………………

Designation: ……………………………………… (must be a dully authorized appointing of officer)

PART III

I have received the original of this letter and a copy of the Zambia Teaching Service Regulations and
agree to accept the terms the therefore and to do my utmost to uphold the highest standards of the
teaching profession.

Date: ……………………………………. Signature of employee…………………………………

NB: Teachers are reminded to complete TS Form 26 in respect of the Government or Local
Government accommodation allocated to them.

If salary payments are required through a bank or building society mandate to this effect to be
completed and attached to this letter.

DISTRIBUTION:

ORIGINAL: To employee
DUPLICATE: To be retained by employer.
TRIPLICATE: Provincial Record
QUADRUPLICATE: To Ministry Headquarters
QUINTUPLICATE: To Mechanized Salaries Section Ministry
Distribution Original Officer
Copies to: Permanent Secretary Ministry of Education
Chief/Education Officer

ZAMBIA CIVIL SERVICE

APPLICATION FOR LEAVE (OTHER THAN SICK LEAVE FOR

A PERIOD OF LESS THAN THIRTY DAYS)
(Officers in Division 1.1 AENEID)

To be completed and forwarded in TRIPLICATE to the Provincial Education Officer/ District

Education Board Secretary.

PART I
(To be completed by applicant)

NAME: ……………………………………………………..TS/NO: ……………………………

APPOINTMENT: …………………………………………. STATION: …………………………
MINISTRY: ………………………………………………………………………………………

Date of commencement of present period of qualifying service………………………….(a) service in

Months since (a) above at present of level proposed leave………………………………………………
Division in which serving…………………… Rate of leave…………………… ………Days a month
Leave granted since (a) above ……………………………………………………………..days
Leave applied for…………………………………. Days the first of which is to be…………………….
Duty to be resumed on …………………………………………………………………………………...
Address during leave……………………………………………………………………………………..
……………………………………………………………………………………………………………

Date: ………………………………….. ……………………………………………………

Signature of Applicant

PART II

(To be completed by District Education Board Secretary Officer)

Leave applied…………………………………………………days.

Signature: ………………………

Date: …………………………………………………. Designation: …………………...

 SCHOOL ESTABLISHMENT
PART A
(TO BE COMPLETED BY APPLICANT)

1. Surname (in capital letters)

……………………………………………………………………………
2. Other Names (in Capital Letters)……………………………………………………………………..
3. National Registration Number………………………………………………………………………..
4. Qualifications…………………………………………………………………………………………
Subject (s) Taught…………………………………………………………………………………….
Proposed Date of Appointment………………………………………………………………………
5. School choice 1………………………………………………………… District……………………
Province………………………………………………………………………………………………
Options selected 2……………………………………………………… District……………………
Province………………………………………………………………………………………………
6. Application’s signature: ………………………………………………. Date: …………………….
7. Certified correct………………………………………………………... (must be dully endorsed by
Principal)

PART B

1. To be completed by the Head of School where applicant is to teach.

Province: ………………………………………………………………………………………….....
Type of School Lower: …………………………………… Upper: …………………………….....
2. Status of School Grade (1,2,3,4) or Ungraded:
…………………………………………………….....
3. School establishment (Official No. of teaching allowed…………………………………………......
4. Current Number of Teachers in the School……………………………………………………….......
5. Number of excess teachers………………………………………………………………………........
6. Shortfall if any (Please indicate number)………………………………………………………..........
7. Number of female teachers……………………………………………………………………….......
8. Number of retired teachers service on temporary appointment…………………………………........
9. Number of other staff……………………………………………………………………………........
Proposed Date of Appointment………………………………………………………………….........
Applications supported/not supported (Cancel appointment)
Name of Head…………………………………………………………………………………….......
10. Comments of the District Education Board Secretary DEBS (Approved/Not Approved)

Name: …………………………………….. Sign…………………… Date: ……………….........

12. Comment of the Provincial Education Officer P.E.O.

Name: …………………………………….Sign: ………………… Date: ………………..........
 REPUBLIC OF ZAMBIA

CS FORM B26
Stocked by Govt.Printers
FORM OF VITAL STATISTICS
(GENERAL ORDERS NO.10)

1. Name of Officer in full:……………………………………………………………………

2. Date of Birth:………………………………………………………………………………..
3. Place of Birth:……………………………………………………………………………….
4. Nationality of Parents: Father:………………………… Mother:…………………………..
5. Religion:……………………………………………………………………………………..
6. Title of Appointment:……………………………………………………………………….
7. Date of Marriage:……………………………………………………………………………
8. Maiden and Christian Names of Wife:……………………………………………………...
Children:
S/ NAME DATE OF BIRTH SEX REMARKS
NO.
1
2
3
4
5
6
7
8

9. (TO BE COMPLETED BY MARRIED WOMEN ONLY)

Name of Husband in full:…………………………………………………………………

Address of Husband:……………………………………………………………………...
……………………………………………………………………….
Husband’s present occupation:……………………………………………………………

10. Names and address of parents and/or other relations or friends whom you would wish to be
notified in the events of serious illness or emergency:
(a) Name:………………………………………………………………………………
Address:…………………………………………………………………………………
Relationship:………………………………………………………………………………
(b) Name:……………………………………………………………………………………
Address:…………………………………………………………………………………
Relationship:……………………………………………………………………………..
Date:……………………………………………Signature:…………………………………….
NOTE – The Permanent Secretary (Personnel) must be informed if any amendment to the
details given above becomes necessary
 TS FORM 8
Stocked by Min. of Education
16m – 1772 6 070 T

TEACHING SERVICE

RECOMMENDATION FOR CONFIRMATION

(Part I and II to be completed in triplicate, Original and Duplicate to be forwarded to

Provincial Education Officer, Triplicate to be retained by Manager, Part IV to be completed by
Manager.

PART I

MEDICAL CERTIFICATE

1. Name:………………………………………… TS /NO.…………………………………
2. Appointment………………………………… Date of first appointment………………….
(Items I and 2 to be completed by Manger)
3. I have examined the above named and find him/her fit/unfit for permanent employment as
an……………………………………………………………………………………………
Remarks…………………………………………………………………………………….
……………………………………………………………………………………………..
Date: ………………………………………………. …………………………………
Medical Practitioner
(* Delete where not applicable)

PART II

RECOMMENDATION BY EDUCATION OFFICER/ HEADTEACHER

1. The above named has served on probation from………………… 20……to date and,
Being eligible for confirmation in appointment on 10………, has expressed the wish to be
confirmed.
2. Present salary is K………….. in scale………………………………………………………
3. Proficiency and process in appointment…………………………………………………….
……………………………………………………………………………………………….
………………………………………………………………………………………………
………………………………………………………………………………………………
4. Conduct and character (details of any adverse report or disciplinary action since date of first
Appointment must be given…………………………………………………………………..
………………………………………………………………………………………………..
……………………………………………………………………………………………….
……………………………………………………………………………………………….
5. Year in which efficiency Bar Examination passed, where applicable………………………
 6. General Remarks……………………………………………………………………………
….............................................................................................................................................
……………………………………………………………………………………………….

7. I recommend that Mr/Miss…………………………………………………………………

8. Be confirmed in appointment with effect from the date on which service on probation
commenced ………………………………………………………. 20…………………..

Date: …………………………………………………… ………………………………..

Manager

PART III

THE PERMANENT SECRETARY

MINISTRY OF EDUCATION

1. Particulars of this employee given in Parts I and II of this recommendation are correct, according to
my records.

2. The Teaching service Committee recommends-

*that Mr/Miss…………………………………………………………………………be confirmed in
*appointment with effect from………………………………………………………., 20…………….
*that Mr/Miss……………………………………………………….should not be confirmed in
Appointment, for the following reason/s………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………

Date: ……………………………………………. ……………………………………………

Provincial Education Officer
* Delete where not applicable
Original: To be forwarded
Duplicate: To be retained for records

PART IV

A. PERSONAL PARTICULARS:

1. Full Name: ……………………………………….. 2. NRC NO: ………………………………..

3. Tribe: …………………………………………….. 4. Village: …………………………………..
5. Chief: ……………………………………………. 6. District: …………………………………
7. Approximate date of Birth: …………………………………………………………………………
B. EDUCATION AND/OR TRAINING:

Dates Final Standard passed

Where Educated and/or Trained From To /Certificate Obtained

…………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

C. PREVIOUS EXPERIENCE:

Previous appointment and names Dates Reason for leaving of previous employment or
Government Department From To

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

D. POSTINGS:

Dates School District Province

From To

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
FOR HEADQUARTERS USE ONLY:
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
CSB31
Stocked by Govt Printer
5m SL705 8/06 4D
APPENDIX III (Vide General Order 9 (a))
REPUBLIC OF ZAMBIA
FORM OF CERTIFICATE OF MEDICAL EXAMINATION
To (1) ……………………………………………………………………………………..

I hereby certify that I have this day examined (2) …………………………………….

…………………………………………………………………………………………….

Candidate for employment as (3) ………………………………………………………

…………………………………………………………………………………………….

and in my opinion he/she is (4) ……………………………….for service in the Republic of Zambia.

………………………………..
Medical Officer
……………………………….. Station

………………………………..20…….

(1) To the Head of Department in charge of candidate.

(2) and (3) to be filled by the Department applying for Medical Certificate.
(4) Medical Officer to insert ‘fit’ or ‘unfit’ as the case may be.
(5) Reverse to be completed on copy for DMS only.

This form may be obtained from the Director of Medical Services, Lusaka.
TO BE COMPLETED ON COPY FOR DMS ONLY
Age………………………… Height……………………….. Weight…………………...
Physique……………………………………. Mental Status……………………………
Previous Illnesses………………………………………………………………………...
…………………………………………………………………………………………….
RESPIRATORY SYSTEM: Girth………………. Full expiration…………………...
(a) Any abnormality on clinical examination………………………………………..
………………………………………………………………………………………
(b) X-ray of chest (where possible)…………………………………………………..

CARDIO-VASCULAR SYSTEM:
(a) Rate and quality of pulse…………………………………………………………
(b) Any cardiac abnormality…………………………………………………………
(c) Blood pressure…………………………………………………………………….
(d) Any varicose veins………………………………………………………………...
ALIMENTARY SYSTEM AND ABNOMEN:
(a) Any symptoms……………………………………………………………………..
(b) Condition of the mouth, teeth and tonsils……………………………………….
(c) Any abnormality of liver or spleen………………………………………………
(d) Any hernias………………………………………………………………………
(e) Any haemorrhoids………………………………………………………………...
GENITO-URINARY SYSTEM:
(a) Any symptoms or abnormality…………………………………………………...
(b) Urine………………SG……… Reaction……….. Alb……. Sugar…………….

INTEGUMENTARY SYSTEM:
(a) Any eruption or ulcer……………………………………………………………..

CNS:
(a) Any symptoms…………………………………………………………………….
(b) Patellar reflexes…………………………………………………………………...
(c) Pupils………………………………………………………………………………
(d) Hearing……………………………………………………………………………
(e) Speech……………………………………………………………………………...
REMARKS:
……………………………………………………………………………………......
………………………………………………………………………………………..
………………………………………………………………………………………..
Date………………… …… …… …………………………….
Station……………………………. Medical Officer
 MINISTRY OF GENERAL EDUCATION

DIRECTORATE OF STANDARDS AND CURRICULUM

TEACHER OBSERVATION/MONITORING FORM

PART A: GENERAL INFORMATION

SCHOOL……………………………………DISTRICT…………………… PROVINCE……………………….

NAME OF TEACHER……………………………………………………….. TS NO……………………………

DATE OF BIRTH…………………………. DATE OF RETIREMENT………………………………………….

DATE OF FIRST APPOINTMENT………………………… DATE OF CONFIRMATION……………………

PRESENT APPOINTMENT…………………………………………. DATE…………………………………….

CONFIRMATION IN PRESENT APPOINTMENT……………………………………. DATE…………………

DATE REPORTED TO PRESENT SCHOOL……………………………………………………………………..

QUALIFICATIONS: ACADEMIC………………………………………………………………………………...

PROFFESSIONAL…………………………………………………………………………

INSTITUTIONS WHERE TRAINED………………………………………………………. YEAR……………

………………………………………………………. YEAR……………

…………………………………………………………YEAR…………...

DATE OF LAST INSPECTION……………………………………………………………………………………

MONITORING OBJECTIVE………………………………………………………………………………………
………………………………………………………………………………………
CLASS……………. SUBJECT……………………………………………………………………………………
TOPIC………………………………………………………………………………………………………………
ENROLMENT OF THE CLASS: BOYS:…….. GIRLS:…… TOTAL………………………………………….
a) NO. OF PUPILS PRESENT ON THE DAY OF MONITORING
BOYS GIRLS TOTAL

b) NO. OF PUPILS WITH SEN

CATEGORY BOYS GIRLS TOTAL
Giftedness/Talent
Visually Impaired
Hearing Impaired
Intellectually Impaired
Physically Impaired
Learning Difficulties
Health
Others
 PART B: LESSSON PRESENTATION
The following ratings will be used to assess the teacher’s performance. Each rating is guided by the
number of points given. A tick should be given to what applies in each case.
RATINGS U= Unacceptable 1 point S= Satisfactory 2 points
G= Good 3 points VG= Very Good 4 points
O= Outstanding 5 points

1. PERSONAL PRESENTATION
U S G VG O
Appearance
Punctuality
Teacher preparedness for the lesson
Voice projection/ Gestures

2. ORGANISATION AND STRUCTURE OF LESSON:

U S G VG O
Lesson objective
Introduction
Development
Consolidation
Conclusion
Home work

3. KNOWLEDGE OF SUBJECT MATTER

U S G VG O
Accuracy
Level and relevance
Logical presentations
Questioning techniques

4. VARIETY AND APPROPRIATENESS OF ACTIVITIES

U S G VG O
Individual
Group/Pair
Whole Class

5.PUPILS’ PARTICIPATION
U S G VG O
Pupils written work
Pupil-teacher rapport(relationship)
Pupil to pupil relationship
Pupils display of interest
Sustained purposeful activities
Pupils home work
6.ATTENTION TO INDIVIDUALS
U S G VG O
Ability to cope with individual pupils work
Remedial teaching
Knowledge of handling CSEN

7.TEACHING AND LEARNING RESOURCES

U S G VG O
Availability of teaching/learning resources, SEN materials inclusive
Nature of resources
Variety
Applicability/Appropriateness
Management of Teaching and Learning Materials
Class Library

8.CLASS MANAGEMENT
U S G VG O
Class Control
Classroom cleanliness
Desk/sitting arrangement

9.TEACHER WORKING DOCUMENTS

U S G VG O
Syllabus
Schemes/Records of work/Weekly forecasts
Lesson plan
Time Table
Internal monitoring schedule
Pupils’ Assessment Record
Period/Class register

10.GENERAL COMMENTS
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
11. RECOMMENDATIONS
11.1 ……………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

11.2 ……………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

12. CERTIFICATION

…………………………………………………. ………………… ………………….

NAME OF STANDARDS OFFICER SIGNATURE DATE

…………………………………………………. ………………… ………………….

NAME OF SCHOOL MANAGER SIGNATURE DATE

…………………………………………………. ………………… ………………….

NAME OF TEACHER SIGNATURE DATE
 TEACHING SERVICE

TS FORM 21
Stocked by Min. Educ.
20m W 584 11.67 S 2 B.

CERTIFICATE OF SERVICE

(To be completed in quadruplicate)

Reference No: …………………………

Name: ……………………………………………………………………………………………………
Period of service from……………………………….20 ……………..to………………………..20……
Position held………………………………………………………………………………………………
Cause of termination of engagement……………………………………………………………………...
* Efficiency……………………………………………………………………………………………….
Date…………………………………………………20………………………………………………….
Approved……………………………………………………………Manager…………………………..

…………………………………………………………………………………………………………….
Permanent Secretary Ministry of General Education

* Efficiency and general conduct to be assessed as “Very Good” “Fall” or Indifferent

TEACHING SERVICE

TS FORM 21
Stocked by Min. Educ.
20m W 584 11.67 S 2 B.

CERTIFICATE OF SERVICE
(To be completed in quadruplicate)

Reference No: …………………………

Name: ……………………………………………………………………………………………………
Period of service from……………………………….20 ……………..to………………………..20……
Position held………………………………………………………………………………………………
Cause of termination of engagement……………………………………………………………………...
* Efficiency……………………………………………………………………………………………….
Date…………………………………………………20………………………………………………….
Approved……………………………………………………………Manager…………………………..
……………………………………………………………………………………………………
Permanent Secretary Ministry of General Education
* Efficiency and general conduct to be assessed as “Very Good” “Fall” or Indifferent
Original to: Ministry of Finance

Triplicate (when used as an arrival Advice only) to: Accts Form No: 81
Stocked by Govt. Printers

REPUBLIC OF ZAMBIA

ARRIVAL ADVICE AND PAYMENT OF SALARY

Establishment File No:………………………………… Finance File No: ……………………………

To be completed by each officer immediately on his return from vacation leave arrival on first
appointment, or whenever it is desired to amend the method of paying salary.

THE SENIOR FINANCE OFFICER (SALARIES)

MINISTRY OF FINANCE
P.O. BOX 50062
LUSAKA

1. SURNAME (IN CAPITAL LETTERS)……………………………………………………………...

FULL CHRISTIAN NAMES (IN CAPITAL LETTERS)……………………………………………
NATIONAL REGISTRATION NO………………………………………………………………….
WORK PERMIT NUMBER WHERE APPLICABLE………………………………………………
DEPARTMENT…………………….........................POST HELD ...................................................
CONDITIONS OF SERVICE- Contract/Probation/Permanent/Temporary.
Returned from vacation leave
2. I have to inform you that I have------------------------------------ on …20…. And have been posted
Arrival on first appointment
to…………………….

3. I returned by………………………………………. Vessel/fight which l

4. Left…………………………
on ……………………in cabin………………… Grade……and disembarked at…………………...
on……………………..20………………………………………….
5. I was accompanied by my wife and family.
6. I was not accompanied by my wife and family, whom I expect to arrive in the Republic about…
and of whose arrival I will advise you immediately upon their return.
7. I reported for duty on ………………………………………………………….. 20………………..
8. Until further notice I wish my salary to be paid:

(a) To……………………………Bank at……………………. Branch……………………………..

(b) By Open Cheque at my own risk…………………………………………………………………
(*see conditions on reverse)

NB: Delete words or paragraphs not applicable.

……………………………………..20……… …………………………………………….
Office’s signature
…………………………………… 20……… ……………………………………………
Permanent Secretary
Head of Department
 Payment of Salary by Open Cheque
Officers requiring payment by Open Cheque are requested tonote carefully that payment by this
means will be made at their own risk. Replacement of an Open Cheque which has miscarried or
has been lost will only be made on completion of the appropriate Form of Indemnity. A specimen
Form of Indemnity is printed below.

In the event of a refusal to sign an Indemnity Form no replacement Cheque will be issued until the
original cheque which has been lost, miscarried, etc, has become state (i.e. after six months have
elapsed from the date of issue of the original cheque.)

Specimen Form of Indemnity

CERTIFICATE OF INDEMNITY
In consideration of the issue to me of a replacement of uncrossed Cheque No:……………………...
K…………………. in payment of…………………………………………………………………....
Which I have (lost , not received, etc)……………………………...I agree to Indemnity the Zambia
Government, the drawer of the cheque against any loss whatever in connection therewith, and I
agree to refund the sum of K……………………..in the event of the original Cheque
No…………..
being paidprovided the Zambia Government undertakes to stop payment of the cheque at the Bank
on which it is drawn, in the form of the advice to the Bank generally used for this purpose.

Signed: …………………………

As witness
………………………………………………………

Date: ………………………………………………..
 VACATIONAL LEAVE FORM
Distribution:
Original to: Officer
Copy to: Permanent Secretary of officers Ministry or Province ZPS II Form (1976)
Permanent secretary, Personnel Stocked by Govt Printer.
Senior Finance Officer (Salaries), Ministry of Finance
District Secretary or Head of Department.

ZAMBIA PUBLIC SERVICE (LOCAL CONDITIONS)

APPLICATION FOR LEAVE AND LEAVE CERTIFICATE

The original and four copies of this form are to be completed by the applicant and forwarded to his
Permanent Secretary, through the District Secretary or Head of Department in accordance with
General Order F44.

PART A

Surname: ………………………………….Other Names: ………………………………………...

Personnel Division File No: ………………...NRC NO: …………………………………………….
Ministry/Province: ………………………….. Ministry File No: ………………………………
Department: …………………………………. Rank: ……………………………………………
Division: …………………………………….. Salary K…………………………………………

Date of return to duty after last leave (or date of Appointment if leave not previously taken …
Date on which leave was last commented………………………………………………………
Date on which leave travel warrant was last received …………………………………………

I now apply to take …………. Days……………… (state type of leave now applied for ordinary,
special, maternity etc – see section of general order} the first of which is to be………………… and to
commute…………………… Days making a total of………………. Days to be deducted from my
earned leave.

I also apply for a leave travel warrant for myself, my wife and ……………children *agree……
From…………………….. to …………………….. and return salary on leave to be paid * in the
normal way in advance up to the last day of the month proceeding my return from leave.

My address on leave will be ………………………………………………………………………...

Date: ……………………………………………………….. ………………………………

Signature of Applicant
 PART B

(To be completed by Head of Department)

The foregoing application is forwarded and recommended. I certify that the details are correct. The applicant is an
established officer/serving on agreement*

Date: ………………………………….Signature: ……………………………..Designation: ………………

PART C

(To be completed by the Personnel Officer’s of the Ministry of Qualifying Service.)

Odd days of qualifying service brought forward from previous application for leave and leave certificate.

Qualifying service from date of return to duty after last leave to date of proposed leave (See note (I);

From: ……………………to ………………………………………. in Division III …………... months………………days

From: ……………………to ……………………………………… in Division II ……………. months………………days
From: ……………………to ……………………………………… in Division I …………….. months………………days
_______________

TOTAL (See not (I}_______________

Equals………………….. completed months of qualifying services and ……………Days of qualifying service to carry
forward. (see note (II)

Earned Leave:

Earned have brought forward from previous application for leave and leave certificate.

………………… ……………………. completed months in Division III @ …………………. Days/months…………

days
………………… ……………………. completed months in Division II @ …………………. Days/months………… days
………………………………………. completed months in Division I @ …………………. Days/months………… days
__________________

TOTAL LEAVE NOW DUE

Less leave now granted ………………....................................days)

Less days commuted………………………………………….days) leave to be carried forward. TOTAL: _________ days
…………...
_________ days

The officer his/her not entitled to leave travel warrants for himself and his dependants as shown in Part A.

The officer may be granted ……………… days’ traveling time in each direction.

Date: ……………………., 20 … Signature: ……………….. Designation:

………………………..
 (To be completed by the Permanent Secretary of the officer’s Ministry/Province)

I hereby certify that Mr/Mrs

Leave with PART D

/Miss………………………………………………………………………...
(i) is now granted: ………………………………… days’ ………………………………………………….pay
…………….. ………………….days’ ……………………………………………. Leave with half pay
…………………………………days’ ……………………………………………... Leave without pay

A total of…………………………days’ leave plus……….. days addition travel leave under General Order F47
commencing on …………………. 20…….......

(ii) is to resume duty on....................................................................................................................20.......................................

Date: …………………………………………………… …………………………………………….

Permanent Secretary

Ministry: ……………………… Province

* Delete as application
* Applicable to Division III Officers only.

NOTES:

1. Qualifying service is the time spent on duty or when sick on full salary. Any other period of absence from duty
does not count as qualifying service.
Ii Each period of thirty odd days is reckoned as one completed month and is calculated at the
leave earning rate as at day of the leave now applied for.

INSTRUCTIONS TO OFFICERS.

1. An officer must provide his Ministry with an address to which correspondence may be caused through
communications not reaching him promptly.
2. An officer who is taken ill so as to require medical attention either during the journey or whilst on leave, and
remain ill for seven days or more, must report the fact to his Permanent Secretary and at the same time, forward a
medical certificate from a registered medical practitioner stating the nature of the illness and, if possible, it
probable duration. Unless this instruction is compiled with, an officer will not be entitled to any salary during any
sick leave which it may be necessary to grant him.
3. An office on leave desiring either an extension of leave or a reduction in the period of leave must submit an
application to his Permanent Secretary stating the grounds on extension or reduction is required.
4. An officer when having been granted leave, fails to return to duty at the proper time, is liable to summary
dismissal.
5. An officer on leave may be required to undertake any course of instruction and to discharge any duty during his
leave and will not be entitled to any additional remuneration in consequence of such employment. An advantage
may however, be granted to cover necessary out of pocket expenses and an extension of leave may be granted
where appropriate.
6. An officer on leave may not accept any paid employment without previously obtaining the section of the
Permanent Secretary, Personnel.
7. Existing arrangements for the payment of salary will automatically apply unless the officer elects to receive his
leave salary in advance.
8. In case officers serving in Division II advances of salary will be paid by the section. Ministry of Finance.
9. In case officers serving in Division III advances of salary will be paid by the officer’s Ministry of Province.
 Republic of Zambia

Ministry of General Education

EMPLOYEE NUMBER:………………NAME OF SCHOOL:………………………………………..

TS NUMBER:………………………….P.O.BOX:………........
DATE:…………………………………MPIKA

The District Education Board Secretary

P.O. Box450144
MPIKA

RE: POST OF SPECIAL RESPONSIBILITY

I recommend that the teacher named below be paid the allowance for his/her post of special
responsibility for teaching senior classes for……………………..term.

NAME POSITION QUALIFICATIONS NRCNO. GRADE(S) TERM

HANDLING

Recommended by: ………………………………………

Position:…………………………………………………..

Signature:……………………..

Date and stamp

Approved by:……………………………………………….
Position:…………………………………………………….
Signature:………………………

Date and stamp

CURRICULUM VITAE
NAME: ………………………………………………………………………………………………………………………...
ADDRESS: …………………………………………………………………………………………………………………….
DATE OF BIRTH: …………………………………………………………………………………………………………….
NATIONALITY: ……………………………………………………………………………………………………………...
NRC NO: ………………………………………………………………………………………………………………………
MARITAL STATUS: …………………………………………………………………………………………………………

ACADEMIC QUALIFICATIONS
(State field of specialization)

DATE FROM TO QUALIFICATIONS INSTITUTION/SCH

PROFESSIONAL AND/OR OTHER QUALIFICATIONS

(State field of specialization)

DATE FROM TO QUALIFICATIONS INSTITUTION/SCH

OTHER RELEVANT TRAINING

(State field of specialization)

DATE FROM TO TRAINING INSTITUTION/SCH

EMPLOYMENT HISTORY
(Starting with the latest position)

DATE FROM TO TRAINING INSTITUTION/SCH

ANY OTHER RELEVANT INFORMATION

……………………………………………………………………………………………………………
 REGIONAL CLEARANCE CERTIFICATE

Ministry of General Education,

P.O. Box 50093,
LUSAKA.
ATTENTION: Personnel DepartmentThe Permanent Secretary,

Please note that Mr/Mrs/Miss: …………………………………. File No: ……………………………

Who was employed in this school/office as : ……………………………………………………………
(Description) has retired/resigned/dismissed: ………………………………………………………….
with effect from: ……………………………………………….. Date: ………………………………
The officer owes the to GRZ which must be recovered or with-held from his terminal payment pending
finalization of pending cases.

S/NO ITEMS AMOUNT DETAILS

1. Water & Electricity Charges

2. School Fund
3. School GRZ Property
4. Loans/Advance
5. Imprests
6. Others (specify)

SCHOOL STAMP I certify that the above information is correct.

(where applicable) Signature of the Head……………………………..
Full Name and File No. ………………………….

NOTE:
Please prepare this form in 5 copies and
Send 4 copies to the DEBS who will send 3copies
to the P.E.O.

DISTRICT EDUCATION OFFICER’S I certify that the above information is correct

Signature of the District Education Officer: …….
Full Name: ……………………………………….
Remarks if any: ………………………………….

I certify that the above information is correct

Signature of P.E.O: ……………………………
Full Name: ……………………………………….
NOTE:
Please check especially whether the
Officer was involved in any of Public property or
Money and send 2 copies with a covering minutes
With a your comment
 Republic of Zambia

Ministry of General Education

MINISTRY OF GENERAL EDUCATION STATISTICAL TEACHER APPLICATION

FORM 1

 The form must be completed in 4 copies by all qualified trained teachers from recognised
Universities and Colleges
 The application form must be submitted to the DEBS offices
 Everything must be in CAPITAL Letters
 Attach certified photocopies of Grade 12 results, College/University and NRC

1.0 PERSONAL INFORMATION

1.1Surname (in CAPITAL) Other Names (in CAPITAL Letters)

1.2. 1.21. National Registration Card Number 1.2.2. Gender (Female/Male)1.2.3. Nationality 1.2.4 Date of Birth

1.3 Place of Birth Village Town/City District Province Other (Country)

1.4 1.4.1. Language (s) Spoken 1.4.2.Marital Status 1.4.3. Number of Children:1.4.4 Any Disability

1.5. College/University Qualification obtained

1.6 Area of Specialization (for Secondary Subject 1 Subject 2

School Teachers only)

2.0 PREFERENCE OF POSTING Province District

2.1 1st Choice Province District

2.2. 2nd Choice Province District

2.3 3rd Choice Province District

I fully accept to be posted where my services are needed and not necessarily to the School/District/Province of my choice.

2.4 Date: 2.5 Name:

2.6 Signature:

3.1 Received by (Name and position)

3.2 Date
3.3 Institutional Ref. No.

Decision of Deployment Committee: Candidate posted to:

3.4 3.4.1 School 3.4.2 District 3.4.3 Province - Rural/Urban

 Republic of Zambia

Ministry of General Education

MINISTRY OF EDUCATION NEW TEACHER ARRIVAL FORM

To be completed by the Head Teacher in 4 copies, One copy to be retained by the school and three copies to be
forwarded to the DEBS immediately.

1.1 Surname of Teacher (in capital letters) Other Names (in capital letters)

1.2 National Registration Card Gender 1.2.4 Nationality 1.2.5 Date of Birth
Number 1.2.2. Female 1.2.3. Male

1.3 College/University where trained

1.4 TS Number

Arrival
Name of School Name of District Name of Province

Date Grades to be taught

Reported to (Name of Head teacher) Teaching Subjects ( high school teachers only)

Name of New Teacher Signature of New Teacher

This serves to confirm that the named teacher has reported to the school named above on the date as
shown.

Signature of Head Teacher

FOR OFFICIAL USE ONLY

Notes/Comments
 CODE OF ETHICS ACKNOWLEDGEMENT FORM

Republic of Zambia

ACKNOWLEDGEMENT

Original Copy to Employee Master File

Send Copy to Ministry /Department

Third Copy to Employee

I, (Print Name)…………………………………………………………………………………… HAVE

ACKNOWLEDGED RECEIPT, READ, UNDERSTOOD AND DO HEREBY UNDERTAKE TO ADHERE

TO THE PROVISIONS OF THE CODE OF ETHICS FOR THE PUBLIC SERVICE.

IN THE EVENT OF ANY VIOLATION OF THE PROVISIONS OF THE CODE ON MY PART, I

UNDERTAKE TO AVAIL MYSELF TO THE DUE PROCESS OF APPLICABLE DISCIPLINARY CODE.

FURTHER, SHOULD I BECOME AWARE OF ANY VIOLATIONS OF THE CODE, I UNDERTAKE TO

NOTIFY THE APPROPRIATE AUTHORITIES.

SIGNED: …………………………. DESIGNATION: ………………………………DATE: ………………….

MINISTRY/ INSTITUTION: ……………………………………………… I, certify that the above named

officer has been provided with a copy of the Code of Ethics for the Public Service and a copy of this form

(CECAF1)on the date indicated above.

Signed: ………………… Name: ……………………………… Designation: ………………. Date: ………….

Head of Human Resources: …………………………………………………………………… Date:……………

CS FORM B25
Stocked byGvtPrinters
REPUBLIC OF ZAMBIA
FORM OF ACKNOWLEDGEMENT OF LIABILITY FOR LOSS OR DAMAGE TO
OFFICER’S PERSONAL EFFECTS
Note on Liability for Loss or Damage to Officer’s Personal Effects PART I

The Liability of the Government in respect of loss or damage to officer’s personal effects is governed by General Order
505, which reads as follows:

‘505’.(a) Government will accept no liability for loss or damage to an officer’s personal effects, with the exception
referred to in paragraph (b) of this Order, unless the loss or damage occurred in circumstances where the Government
might legally be liable.

‘(b) Where an officer and his family are travelling by train at Government’s expense, Government will assume
liability to the same degree as that which the railway company assumes towards the holders of an ordinary ticket. This
applies to an officer travelling by passenger train on duty or on transfer or going to and from leave with concession tickets,
and to an officer travelling on duty by goods train.

‘(c) In special circumstances Government will assume the liabilities of a common carrier, that is, it will pay
compensation if loss or damage is proved although this has not been caused by negligence. These circumstances relate to
the properly authorised carrying an of an officer’s effects by Government transport-

‘(i) when the officer is travelling on duty in Zambia, and when, if he had used public transport,
Government would have paid the cost of carrying his effects; or

‘(ii) when an officer is stationed at a place which is not served by public transport, and his effects, including
household supplies, are being carried in Government transport making the journey on duty.
Government’s liability in these cases is limited to K20 for specified articles including gold, jewellery, watches, clocks,
pictures, plates, glass, chairs and funs, unless the individual values of these articles have been declared in advance. Full
compensation may be paid if the loss or damage can be shown to be due to negligence of a Government employee, other
than the officer himself.

‘(d) Except as provided in paragraph (c) above, Government will accept the liability when Government transport is
authorised to carry an officer’s personal effects between one set of Government quarters and another at the same station, or
house and any other place where his effects are to be stored or have been stored.

‘(e) Government will accept no liability when an officer’s personal effects are carried by a commercial contractor.

‘(f) Government will accept no liability for the loss or damage ton an officer’s effects which are kept in a
Government store, even though loss or damage may have resulted from the negligence of a Government employee. Before
an officer’s effects are accepted, for storage in the Government store, he must sign a form accepting this condition.

‘(g) When an officer’s effects are stored in a Government store during his leave, his written agreement must be
obtained before the effects are moved to another station.

‘(h) The cost of insuring an officer’s effects will not be paid by Government. Officers must make their own
arrangements with insurance companies.

Part II of this form, below should be completed, detached and returned to the Permanent Secretary (Personnel)
Lusaka

…………………………………………………………………………………………………………………………………………………………………

To: PART II
THE PERMANENT SECRETARY (PERSONNEL)
LUSAKA
I, ………………………………………………………………………………………………………………………………
have received a copy of CS Form B25 Part I- a Note on Liability for Loss or Damage to Officers’ Personal Effects
and am aware of my own liability in respect of any loss or damage to my personal effects.
Signature: ……………………………………………….
Title: ……………………………………………………

MINISTRY OF GENERAL EDUCATION

MPIKA DISTRICT

EMPLOYEE NUMBER ………… NAME OF SCHOOL......................................

TS NUMBER …………… P.O BOX.........................................................

DATE ……………………

The District Education Board Secretary

P.O. Box 450144
MPIKA.

RE: DOUBLE CLASS ALLOWANCE

NAME POSITION NRC NO GRADES STATION TERM

HANDLING

Recommended by…………………………………………………………
Position …………………………………………………………………..
Signature …………………………………………………………………
Date stamp

Approved by…………………………………………………………….
Position …………………………………………………………………..
Signature …………………………………………………………………
Date stamp

Appendix 5
DHRD Form 5

REPUBLIC OF ZAMBIA

PUBLIC SERVICE MANAGEMENT DIVISION

DEPARTMENT OF HUMAN RESOURCE DEVELOPMENT

BONDING AGREEMENT
Please complete five (5) copies in own handwriting and submit as originals

This bonding Agreement made on this………..(Day) of ……….(Month)……………(Year) is

made between the Government of the Republic of Zambia (hereafter called the Government
and name …………………………………………………(Hereafter called the applicant)

NRC Number:…………………………………………………………..Staff No:…………………………….

PMEC No……………………………………..Job Title:………………………………………………………
Ministry/Province/Institution:………………………………………………………………………………
Department:…………………………………………………Station:…………………………………………
In this Agreement the applicant agrees that in return for the Government sponsoring the
training which commences on……………………..(insert starting date) and ends
on……………….. (insert due date for completion) or to later date if the period of sponsorship
is subsequently extended with approval of the Government, that the applicant agrees to be
bound to return to serve with the Government for the same total period of time as that of
sponsorship on completion of the said sponsorship.

NOW THEREFORE it is agreed both parties hereto that:-

In consideration of the admission of the candidate to the course selected by the
Government and the payment by the Government of the expenses of the incidental to the
course, the amount of which shall be at the absolute discretion of the Government, the
applicant hereby undertakes to the Government.

i)To follow the prescribed course of study to completion to the best of his/her ability and in
so far as he/she is capable of learning and in accordance with the directives contained in
the rules binding applicants on training hereto and deemed hereby to be incorporated
herein and in accordance with such other directives as may from time to time be given to
him/her in writing;

ii) At the conclusion of the course, to return to fulfil the duties of his/her substantive
post or to such other post as the Government may direct;
iii) To repay the Government all expenditure incurred by the Government in connection
with his/her course including (but not limited to) any funds paid to him/her and or his/her

behalf by way of salary, allowances, fees and expenses, and the cost of transport if the
applicant contravenes or fails to comply with the conditions of clauses (i) and (ii) hereof.

iv) In the event of the applicant failing to serve the Government continuously on his/her
return to duty at the end of the course for the period equal to the full period of the
training either because of his/her resignation or because he/she is dismissed on
grounds of misconduct or inefficiency, to repay the Government all expenditure
incurred by it in connection with his/her course or such proportion thereof as the
Government may direct;

v) In the event that applicant fails to voluntarily repay the expenditure incurred by
Government as indicated in clause (iii) repayments shall be affected through deductions
from the separation package. Further, the Government may have recourse to legal action to
recover any outstanding balances.

The parties hereto are deemed to have mutually agreed upon the said repayments as
genuine pre-estimates of the loses sustainable by Government in the event referred to and
to have stipulated for these repayments as liquidated damages and not by way of penalty.

Nothing contained in this agreement shall be construed as imposing any liability on the
Government to continue to employ the candidate.

SIGNED BY THE SAID APPLICANT

Full Name:………………………………………………Signature:………………………Date:……………

SIGNED ON BEHALF OF THE GOVERNMENT OF THE REPUBLIC OF ZAMBIA

(To be signed by Responsible Officer/Director HRA)

Name:………………………………………………………Designation:……………………………………

Signature:…………………… Date:…………………………

Official Stamp……………………………..

IN THE PRESENCE OF (WITNESS)

Name:…………………………………………………………Designation:………………………………….

Signature:………………………Date:…………………………………………..
 RULES BINDING APPLICANTS ON TRAINING

Every applicant selected to attend a course is required to comply with the following
rules:-

(a) To obtain written authority from Government before proceeding for studies;

(b) To proceed to the approved institution of the course as directed (both as to the time

and means of travel) and not transfer to another station without authority;

(c) To begin his/her training at such time as may be directed and to continue diligently

with such training until completion of the course unless he/she is prevented from

doing so by sickness proved by a certificate from a registered medical practioner or

other circumstances accepted by Government as beyond his/her control;

(d) To follow any directive which may be given to him/her by the Officer responsible for

the course;

(e) To devote his/her full time and attention to follow the course for which he/she was

selected unless permission to undertake other work or modify his/her course in

content or duration is granted in writing by the Government;

(f) All times to comply with the requirements of the course regarding the conduct and

discipline

(g) To update Government on the progress of his/her course by submitting examination

results regularly;

(h) Failure to satisfactorily progress on a course due to illness, Government may direct

him/her to be medically examined by a registered medical practioner to determine

his/her fitness to continue the course; and,

(i) To sit for any prescribed examinations unless he/she is prevented from doing so

through sickness proved by a certificate from a registered medical practioner or by

other circumstances accepted by Government as beyond his/her control.

 Distribution list:Public Service Management Division Appendix 3
Department of Human Resource Devpt DHRD Form 3
Auditor Generals’ Office
Ministry
Applicant

REPUBLIC OF ZAMBIA
PUBLIC SERVICE MANAGEMENT DIVISION
DEPARTMENT OF HUMAN RESOURCE DEVELOPMENT

APPLICATION FOR STUDY LEAVE

Complete five (5) sets, and attach the completed Bonding Agreement Form to each set which should be submitted to Permanent
Secretary,
PSMD
PART 1
(To be completed by applicant)

A. BIO-DATA

Surname:……………………………………………
Forename (s)……………………………………………………..
TS/Force/S.No:…………… PMEC No.:……………… NRC No.:…………………..
Date of Birth:……………… Gender:………Marital Status:…………………………
B. QUALIFICATIONS
Highest Qualifications and Date obtained:…………………………………………

Institution and Country:……………………………………………………………

Indicate latest training attended:

Programme Name:………………………………………………………………….

Commencement Date:………………Completion Date:……….Duration:……….

Level (Degree, Diploma, Certificate, etc):…………………………………………

C. WORK RECORD

Ministry:………………………Province/Station:………………………………..

Date of first appointment to Public Service:……………………………………….

State whether confirmed or not confirmed:………………………………………...

(Please attach proof of confirmation to Permanent and Pensionable

establishment)
 Substantive Post:…………………………………………………………………

Job Specification (Minimum qualification for the job):……………………………

Main duties:………………………………………………………………………...

……………………………………………………………………………………

……………………………………………………………………………………

D. PROPOSED TRAINING PROGRAMME

Field of study (e.g. Health, Education, Agriculture, etc): ……………………

Name of Programme:………………………………………………………………

Commencement Date:…………….Completion Date:…………….

Duration:……………….

Level (Degree, Diploma, Certificate, etc):………………………………………

Name of institution:………………………………………………………………

Sponsors (s):……………………………………………………

Country of study:……………………………………..

I declare that the above details are to the best of my knowledge a correct statement of the information

required

Signature:…………………………… Date:……………………………
 PART II
(To be completed by HRD Unit)
Please complete either A or B. Delete not applicable

A. CONFIRMED OFFICERS

I wish to confirm that the applicant is confirmed in the permanent and pensionable establishment

B. UNCONFIRMED OFFICERS

I wish to state that the applicant is not confirmed in appointment for the following reasons:

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

The following measures have been taken to have the applicant confirmed:

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

Name in full:……………………………………Signature:……………………………..Date:…………….

PART III

A. To be completed by Supervising Officer

Explain the relevance of the training programme to the applicant’s present job:

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

Recommend/Not recommended

Name in full:……………………………………………………………… ……….Signature:…………...

Position:………………………………………………………… Date:………………………………………
 B. To be completed by Head of Department

Comments:

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

Approved/Not approved

Name in full:…………………………………………….. Signature:…………………........

Date stamp:………………

PART IV
(To be completed by the Responsible Officer)
The applicant shall be bonded in accordance with existing regulations. While the
applicant is attending the course, operations of the Department shall not be disrupted.
I recommend that Paid/Unpaid Study Leave be granted.
(Delete as applicable)

Name in full:………………………………………………………………Date Stamp:

……………………………………
Signature:…………………………………………………………….
Permanent Secretary
__________________________________________________________________________________
PART V
(To be completed by the Secretary to the Cabinet/Permanent Secretary, Public Service
Management Division)
Part-time / Distance Study approved/Not approved
(Delete not applicable)

Name in full:…………………………………………….. Signature:……………………

Date Stamp:………….......
Secretary to the Cabinet
Permanent Secretary, Public Service Management Division
(Delete not applicable)
 PMEC FORM OA
Employee Personal and Employment Data Update Form

Institution: ________________________________________________________________________________

Department: _______________________________________________________________________________

Section: ___________________________________________________________________________________

Unit: _____________________________________________________________________________________

Post Id: _____________________________________ Post Name: ____________________________________

NRC No.: ____________/____/____ Man No.: ______________ Post Grade: ____________

Title: ________________________________________________ Payroll Grade: __________

Surname: _________________________________________________________________________________

First Name: ________________________________________________________________________________

Other Names: ______________________________________________________________________________

Maiden Name: _____________________________________________________________________________

Academic Qualifications: _____________________________________________________________________

_____________________________________________________________________
Highest Qualification Level: __________________________________________________________________
Sex (M/F): ____________ Date of Birth: ____/____/_____ Marital Status: ______________
Date Employed: ____/____/____ Employment Type: ____________________
Date of Present Appointment: ____/___/____ Disability: ___________________________
Contract End Date (If on Contract): ___/___/____ Pension Fund or NAPSA P/N: ________________________
Residential Address: _________________________________________________________________________
____________________________ Town/ Village: _______________________________
Postal Address: _____________________________________________________________________________
Tribe: __________________________________ Religion: ____________________________________
Next of Kin: ___________________________________ Kin’s Address: _______________________________
Name of Spouse: ___________________________________________________________________________

Children: Name Sex (M/F) Date

1. _____/_____/______
2. _____/_____/______
3. _____/_____/______
4 _____/_____/______
5. _____/_____/______
6 _____/_____/______
7. _____/_____/______
8. _____/_____/______
9. _____/_____/______
10 _____/_____/______

Name of Bankers: _________________________________ Bank A/C No: _____________________________

Any amount of Loan: (K)__________________ (In Words): ________________________________________
Loan Got From Which Institution: ______________________________________________________________
Signature:___________________________ Date:
____/____/____

APPLICATION FOR RETIREMENT FROM THE PUBLIC SERVICE UPON ATTAINING FIFTY-
FIVE (55), SIXTY (60) OR SIXTY-FIVE (65) YEARS OF AGE

PART I

Names of Officer; …………………………………………………………………………………………………

Employee No: ………………………………………Position……………………………………………………

File No.AE/S: ………………………………………NRC: ……………………………………………………

Date of Birth: ……………………………………….. Sex: ……………………………………………………...

Ministry: ……………………………………………… …………………………………………………………...

Province: ……………………………………………… District: …………………………………………………

Date of First Appointment to Public Service: ……………………………………………………………………...

Years of Service at Proposed Date of Retirement: …………………………………………………………………

PART II

State the positions you have held in the last ten (10) years and the dates of Appointment to those positions

(Substantive Positions):

No. Position (s) Date(s) of Appointment

1
2
3
4
5

PART III-Retirement Option

Preferred retirement option

Tick appropriate box (space)Date of Retirement

i. Early Retirement (55 years) ………………………. ……………………

ii. Normal Retirement (60 years) ………………………. …………………….
iii. Late Retirement (65 years) ………………………. …………………….
What are the reasons for your preferred retirement option?

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Ican confirm that Dr/Mr/Mrs …………………………………………………………………………. Will be

fifty-five (55), sixty (60) or sixty-five (65) years old on……………………………………..and recommend that
he/she retires from Public Service with effect from ………………………………………………………………..

Name of Supervisor:
………………………………………………………………………………………………...

Signature: …………………….........................................................................

Ministry/Province…………………………………………………………….

Thank You.
 REPUBLIC OF ZAMBIA

PUBLIC SERVICE MANAGEMENT DIVISION

PUBLIC SERVICE QUALIFICATION AUDIT DATA COLLECTION FORM

PART I PERSONAL PROFILE

SURNAME: ……………………………………………………………………………………………………….

OTHER NAMES: ………………………………………………………………………………………………….

DATE OF BIRTH: ……………………………… GENDER: MALE ( )FEMALE ( )

NRC NUMBER: …………………………………. EMPLOYEE NO: …………………………………………...

MINISTRY/ PROVINCE/INSTITUTION: ………………………………………………………………………..

………………………………………………………………………………………………………………………

DATE OF FIRST APPOINTMENT: ………………………………………………………………………………

DATE OF PRESENT APPOINTMENT: …………………………………………………………………………

SUBSTANTIVE POSITION: ……………………………………………………………………………………...

PART II QUALIFICATION

ACADEMIC QUALIFICATIONS:

(Please tick where applicable)

GRADE 9 ( ) GRADE 12 ( ) OTHERS () SPECIFY: …………………………

 PROFESSIONAL/ VOCATIONAL QUALIFICATIONS

S/N QUALIFICATION LEVEL OF STUDY INSTITUTION YEAR

ATTENDED OBTAINED

PART III CURRENT TRAINING BEING UNDERTAKEN

S/ COURSE/ CURRENT FINAL START FINISH INSTITUTION

N PROGRAMME STAGE QUALIFICATION DATE DATE

NOTE: Kindly attach photocopies of listed qualifications.