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    Job Application Form ksm2 1

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    bartican emba
    Application form

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Job Application Form ksm2 1

    Uploaded by

    bartican emba
    16 views4 pages
    Application form

    Original Title

    Job-application-form-ksm2-1

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    Application form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    16 views4 pages

    Job Application Form ksm2 1

    Uploaded by

    bartican emba
    Application form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    REPUBLIC OF KENYA

    KISUMU COUNTY

    COUNTY PUBLIC SERVICE BOARD

    APPLICATION FOR EMPLOYMENT FORM


    Please complete all sections of this form in BLOCK letters as appropriate and submit to the Secretary, Kisumu County Public Service
    Board, P.O. BOX 7792, 40100 KISUMU, KENYA. Attach copies of your National ID, Academic Certificates, Testimonials and Clearance
    Certificates
    1. Vacancy Applied For

    Vacancy/Post: …………………………………………………………………………... Vacancy No……………….…………………………………

    Ministry/Department………………...……………………….….…………………

    2. Personal Details of the Applicant

    Name of applicant: ……………………………….…. …………..………….…..……..… ……………………………… Title……………………


    (Surname) ( First Name) Other Name(s): (Prof/Dr/Mr/Mrs/Miss/Ms/Rev)

    Date of Birth…………………………PIN NO……………...…………… ID/Passport No……………...…………… Gender: Male Female


    (dd-mm-yyyy)

    Nationality………………………...…………… Ethnicity………………………….….….……… Home County………………………….……………

    Home Sub-County……………...………………………..……………………… Home Ward…………………...………………………………………

    Postal Address…………………………………………… Postal Code…………………. Town/City…………….………………………………..…..…

    Telephone……………………….….….………………... Mobile……………………………… Email……...…………………………………………...

    Alternative contact person……….……………….......................................................................Telephone……………………….……………………….

    Do you suffer from any physical impairment? Yes No

    If Yes, give;
    (i) Details/Nature of disability …………………………………………………………………………...……………………………….……

    (ii) Registration No and Date for National Council for People with Disabilities…………………………………………………………………

    3. Applicants in the Public Service Only

    Ministry/Department/County Government/Other Public Institutions……………....……………………………. County…………………….………

    Personal/Employment No…………………………… Present Substantive Post………………………………………………………….…………………

    Job group ……………………… Effective date…………………….….


    (dd-mm-yyyy)

    Upgrading post (if applicable) ………………………………………………………………………………Effective date……………………………….


    (dd-mm-yyyy)

    On Secondment (if applicable): Organization …………………………………………Designation …………………………… Job group …….….….

    Terms of Service: Permanent & Pensionable Contract Temporary Other, please specify…………………………….

    4. All other Applicants

    Current employer (if applicable) ……………………….………………………….………Position held………………………………………….…….


    .
    Effective date……………….……………………………. Gross Salary (monthly) Ksh.……………………………………….………………………….
    (dd-mm-yyyy)
    5. Other P e r s o n a l Details

    Have you ever been convicted of any criminal offences or a subject of probation order? Yes No

    If Yes, state nature of offence, year and duration of conviction……………………………….………………….………………………………………


    ………………………………………………………………………………………………………………………………………………………………..
    Have you ever been dismissed or otherwise removed from employment? Yes No

    If Yes, state reason(s) for dismissal/removal……………………………………………………………………………. Effective date…………………


    (dd-mm-yyyy)
    Have you ever been interviewed by Kisumu County Public Service Board before? Yes No

    If Yes, State the Post…………………………………...…………………………………………………………… Interview date……………………….


    (dd-mm-yyyy)
    (Declaring the above information will not necessarily debar an applicant from employment in Public Service. Each case will be considered on its
    own merit)

    6 Academic /Professional/Technical Qualifications (Starting with the Highest)

    Award/Attainment
    University/College/ (e.g Degree, Courses Subject
    Year Institution/School (e.g PhD, Msc, BA) (Econ,Maths e.t.c) Class/Grade
    Diploma,
    Attained
    Certificate)
    From To

    7. Other Relevant Courses and Training a t t e n d e d L a s t i n g n o t L e s s t h a n O n e ( 1 ) W e e k

    Year Institution/College Courses Details and Duration


    8. Professional Membership

    Professional Body Membership/ Membership Type Date of Renewal


    Registration Number (e.g. Associate, Full etc.)

    9. Employment Details – where applicable (starting with the current or most recent)

    Year Employer’s Name Position/ Job Group/


    Designation Gross Monthly Salary
    (Ksh.)

    From To
    (dd-mm-yyy) (dd-mm-yyyy)
    10. Briefly state your current duties, responsibilities and assignments (if any)
    …………………………………………………………………………………..………………………….…
    ………………………………………………………………………………………………..………………..
    .....…..……………………………………...………………………………………………………………..…
    …………………….…………………..…………….……...……..………………………………………..…
    ………………………………………………………………………………………..………………….……
    ………………………………………………………………………………………………………….…...…
    ………………………………………………………………………………………………………………....
    11. Please give details of your abilities, skills and experience which you consider are relevant to the position applied for. The information may
    include an outline of your most recent achievements and your reasons for applying for this post
    …………………………………….……………………….…..…..………….……………………………...
    ………………………………………………………………………………………………………………..
    ………..………………………………………………………………………………………………………
    ..………………….…………………………………..…………….…………………………………………
    ………………………………………………………………………………………………………………..
    .…………………………………………………………………………………………………………….…
    ………………………………………………………………………………………………………………..
    12. Mandatory Requirements

    These are mandatory requirements in compliance with chapter six (6) of the constitution and Leadership and Integrity Act. You are required to
    attach current copies of the following documents.

    1. Clearance from Higher Education Loans Board


    2. Clearance from Criminal Investigation of Department
    3. Clearance from Credit Reference Bureau
    4. Clearance from Ethics and Anti-Corruption Commission
    5. Clearance from Kenya Revenue Authority (Tax Compliance Certificate)

    13. Personal References

    The names of distinguished persons should not be used unless they really know you well; the names of relatives or of those from whom you
    send testimonials should not be used. The names of members or staff of the Kisumu County Public Service Board should also not be used.

    1. Full Name: …………………………………………………………………………..…………………………………………..………………………

    Address: ……………………………………………………………Post Code ……………………City/Town………………….………………………...

    Telephone No:…………………………………………………………… E-mail address:………………………………………………………..............

    Occupation: …………………………………………………………………………………...…………………………………………………………….

    Period for which he/she has known you: ………………………………………..………………………………………………………………………….

    2. Full Name: ……………………………………………………………………………….……………….……………………………………………

    Address: ………………………………………………………………Post Code …………………City/Town………………….………………………..

    Telephone No: ……………………………………………. E-mail address…………………………………………………………………….…………

    Occupation: ………………………………………………………………………………………………..…………………………….………………….

    Period for which he/she has known you: ……………………………………………………………….…………………………………….…………..

    Declaration:

    I hereby certify to the best of my knowledge that the particulars given on this form are correct and I understand that any incorrect information
    may lead to disqualification/legal action.

    Date: ……………………………. ……………………………..


    (dd-mm-yyyy) Signature of the Applicant

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