Application Form

Application Number National Identification Number Bank Verification Number

NNR37/2024/PLA/2886/0082756 14628128598 22623664922

Category Exam State Exam Center

Health Technicians - F2 Kaduna NAF BASE KADUNA

Title Surname First Name

Mr DORO DABWAN

Other Name Height Religion

PAM 1.99 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, July 4, 2000

State of Origin LGA of Origin Mobile Number

Plateau Riyom 08088655077

Home Town Permanent Address

Jos Jol village of Riyom

Parent/ Guardian Detail

Full Name Contact Address

Pam Doro Jol village

Next Of Kin

Full Name Relationship Mobile Number

Nehemiah Dauda Brother 08163620322

Occupation Contact Address

Student Rahol kak Gyel Along Shalom Primary School Bukuru
 Application Form
Referee Details

Referee Name Phone Referee Address

Gyang Doro 09042111271 Jol village

Pam Doro 08138844514 Jol village

Primary Details
School Qualification From To

Dabwan Pam Doro fslc 2005 2012

Secondary Details

School Qualification From To

Victory Secondary School neco 2014 2019

SSCE / NECO / WASSCE / GCE

Subject Grade Examination

Mathematics C5 CREDIT 0140246

English C5 CREDIT 0140246

Physics C5 CREDIT 0140246

Chemistry C6 CREDIT 0140246

Biology C5 CREDIT 0140246

Tertiary Details

Course of
Institution Study Type From To Grade

Plateau State College of Health Technology Public Health ond 2021 2024 pass
Zawan
 Application Form
APPLICANT'S DECLARATION

Application Number
NNR37/2024/PLA/2886/0082756

Application Number: NNR37/2024/PLA/2886/0082756

I DORO DABWAN , hereby declare that the information given in this application is true and that if found to be false I
should be prosecuted.

Signature: _______________________________ Date: _______________________________

Certification by Parents / Guardian

I _____________________________________ parent/guardian of ______________________________________, who is applying for

recruitment into the Nigerian Navy, hereby certify that I fully understand that my child/ward will (if required to)
attend the Recruitment Exercise and I shall not demand compensation or relief from the Government in respect of
death or any injury which my child/ward may sustain in the course of or as a result of any task given to him/her
during the exercise.
Parent / Guardian Witness
Name: _________________________________ Name: _________________________________
Address: _______________________________ Address: _______________________________
Signature: _______________________________ Signature: _______________________________
Date:_______________________________ Date:_______________________________
 Application Form
LOCAL GOVERNMENT AREA CERTIFICATION

Application Number
NNR37/2024/PLA/2886/0082756

Title Surname First Name

Mr DORO DABWAN

Other Name Height Religion

PAM 1.99 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, July 4, 2000

State of Origin LGA of Origin Mobile Number

Plateau Riyom 08088655077

Home Town Permanent Address

Jos Jol village of Riyom

Certification by LGA Chairman / Secretary Or Senior Military Officer not

below the rank of Commander or equivalent Or Chief Superintendent Of
Police from Applicant's State of Origin

I certify that the applicant ____________________________________________ is an indigene of _____________________________

L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct.
I hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.

Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
 Application Form
POLICE CERTIFICATION

Application Number
NNR37/2024/PLA/2886/0082756

Title Surname First Name

Mr DORO DABWAN

Other Name Height Religion

PAM 1.99 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, July 4, 2000

State of Origin LGA of Origin Mobile Number

Plateau Riyom 08088655077

Home Town Permanent Address

Jos Jol village of Riyom

Certification by LGA Chairman / Secretary Or Senior Military Officer not below the rank of
Commander or equivalent Or Chief Superintendent Of Police from Applicant's State of
Origin
I certify that the applicant ____________________________________________ is an indigene of _____________________________
L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct.
I hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.
Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
Certification by Divisional Police Officer
I certify that the applicant _________________________________ is an indigene of ______________________Town,
_________________________ L.G.A, ________________ State and that his/her parent hails from __________________________ L.G.A.
of _________________ State. That he/she has no criminal record on him/her. (If any state briefly
___________________________________________________________________________________________________________________________________
That to the best of my knowledge and belief the facts stated in the form are correct and I hereby declare that if any
statement made in connection with this application is proven to be false I should be prosecuted.

Name:_______________________________
Address:_______________________________
Signature:_______________________________
Date:_______________________________