Times Tower, Haile Selassie Avenue

PO Box 48240 00100 GPO NAIROBI

PERSONAL HISTORY FORM

SHORTLISTING NO.KRA/'43'SUP-IAD-RM-24_22_2022/74

PLEASE READ CAREFULLY AND FILL IN EACH SECTION CLEARLY AND COMPLETELY IN BLOCK/CAPITAL LETTERS
(ALL FIELDS ARE MANDATORY. YOUR CV IS NOT A SUBSTITUTE)

ATTACH RECENT POSITION APPLIED: *INTERNAL CANDIDATES ONLY*

PHOTOGRAPH
CURRENT JOB TITLE:

GRADE:

DEPARTMENT/DIVISION:

DUTY STATION:

PERSONAL INFORMATION
FAMILY/SURNAME:
FIRST NAME:
MIDDLE NAME:
MAIDEN NAME (IF ANY):
ADDRESS AT WHICH YOU RESIDE AT PRESENT:

HOME RESIDENCE (IF DIFFERENT FROM A):

TELEPHONE NUMBER (MOBILE):

TELEPHONE NUMBER (ALTERNATIVE):
E-MAIL ADDRESS:
E-MAIL ADDRESS (ALTERNATIVE):
DATE OF BIRTH:
PLACE OF BIRTH:
CURRENT NATIONALITY:
ETHNIC GROUP:
COUNTY OF BIRTH:
COUNTY OF RESIDENCE:
NATIONAL ID NO.:
PIN:
NSSF:
NHIF:
GENDER: MALE FEMALE
MARITAL STATUS: SINGLE MARRIED DIVORCED
WIDOW(ER) SEPARATED
HAVE YOU ANY FAMILY MEMBERS/RELATIVES* YES NO
WORKING IN KRA? IF YES, GIVE NAME & RELATIONSHIP:

PHF (Rev July 2017)

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

DO YOU HAVE YOU ANY FAMILY YES NO

MEMBERS/RELATIVES WORKING IN THE PUBLIC IF YES, GIVE NAME, RELATIONSHIP AND ORGANIZATION:
SERVICE? …………………………………………………………………………………………
…………………
ARE YOU A PERSON WITH DISABILITY (PWD)? YES NO

DESCRIBE THE NATURE OF DISABILITY:

LIST DEPENDANTS (STARTING WITH SPOUSE, IF APPLICABLE)

Name Date Of Birth Relationship
(DD/MM/YYYY)

LANGUAGES
PROFICIENCY LEVEL (TICK THE APPROPRATE BOX) EXCELLENT GOOD FAIR POOR

ENGLISH : SPEAKING LEVEL

ENGLISH : WRITING LEVEL
KISWAHILI : SPEAKING LEVEL
KISWAHILI : WRITING LEVEL
OTHER LANGUAGE:

COMPUTER SKILLS
PROFICIENCY LEVEL (TICK THE APPROPRATE BOX) EXCELLENT GOOD FAIR POOR

COMPUTER SKILLS: MS WORD LEVEL

COMPUTER SKILLS: MS EXCEL LEVEL
OTHER COMPUTER SKILLS:

MEMBERSHIP IN CURRENT & RELEVANT THE PROFESSIONAL BODIES

MEMBERSHIP NAME OF THE PROFESSIONAL BODY DATE OF REGISTRATION / LEVEL
NO EXPIRY (FROM MM/YYYY) /
TO (MM/YYYY)

2
 EDUCATION AND QUALIFICATIONS
GIVE DETAILS STARTING FROM MOST RECENT EDUCATION.
INCLUDE SHORT COURSES AND POSTGRADUATE STUDIES.
INCLUDE RECOGNIZED CHARTERS AND CERTIFICATIONS.
INCLUDE MEMBERSHIP TO RELEVANT PROFESSIONAL ASSOCIATIONS/SOCIETIES.
FROM TO NAME OF SCHOOL TYPE OF COURSE CERTIFICATE/
(MM/YYYY) (MM/YYYY) DIPLOMA/DEGREE
OBTAINED

EMPLOYMENT RECORD
GIVE DETAILS STARTING FROM MOST RECENT POSITION/EMPLOYER.
IF IT IS ONE EMPLOYER, KINDLY INDICATE THE POSITIONS HELD STARTING WITH THE MOST CURRENT
EMPLOYMENT/POSITION 1 (CURRENT OR MOST RECENT):

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
PERIOD (MONTH/YEAR): FROM: TO:
BASIC MONTHLY SALARY (IN KSH): STARTING: MOST RECENT:
INDICATE ANY ALLOWANCES OR BENEFITS

BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

REASON FOR INTEREST IN THE ADVERTISED POSITION:

EMPLOYMENT/POSITION 2:

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
NUMBER AND TYPE OF EMPLOYEES
SUPERVISED BY YOU, (IF ANY):
PERIOD (MONTH/YEAR): FROM: TO:
BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

3
REASON FOR CHANGING EMPLOYMENT:

EMPLOYMENT/POSITION 3:

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
NUMBER AND TYPE OF EMPLOYEES
SUPERVISED BY YOU, (IF ANY):
PERIOD (MONTH/YEAR): FROM: TO:
BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

REASON FOR CHANGING EMPLOYMENT:

EMPLOYMENT/POSITION 4:

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
NUMBER AND TYPE OF EMPLOYEES SUPERVISED
BY YOU, (IF ANY):
PERIOD (MONTH/YEAR): FROM: TO:
BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

REASON FOR CHANGING EMPLOYMENT:

EMPLOYMENT/POSITION 5:

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
NUMBER AND TYPE OF EMPLOYEES SUPERVISED
BY YOU, (IF ANY):

4
PERIOD (MONTH/YEAR): FROM: TO:
BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

REASON FOR CHANGING EMPLOYMENT:

EMPLOYMENT/POSITION 6:

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
NUMBER AND TYPE OF EMPLOYEES SUPERVISED
BY YOU, (IF ANY):
PERIOD (MONTH/YEAR): FROM: TO:
BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

REASON FOR CHANGING EMPLOYMENT:

EMPLOYMENT/POSITION 7:

NAME OF EMPLOYER:
EXACT TITLE OF YOUR POST:
TITLE OF SUPERVISOR:
NUMBER AND TYPE OF EMPLOYEES SUPERVISED
BY YOU, (IF ANY):
PERIOD (MONTH/YEAR): FROM: TO:
BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES:

REASON FOR CHANGING EMPLOYMENT:

REFERENCES
LIST THREE PERSONS, NOT RELATED TO YOU, WHO ARE FAMILIAR WITH YOUR CHARACTER AND
QUALIFICATIONS. DO NOT REPEAT NAMES OF SUPERVISORS LISTED ABOVE

FULL NAME CONTACT (EMAIL & TELEPHONE) TITLE & OCCUPATION

5
 *WE WILL SEEK REFERENCES FROM YOUR PRESENT/MOST RECENT EMPLOYER WHEN AN OFFER IS BEING
CONSIDERED. KINDLY SPECIFY IF YOU WOULD HAVE ANY OBJECTION AND THE REASON.

I CERTIFY THAT THE STATEMENTS MADE BY ME IN ANSWER TO THE QUESTIONS ABOVE ARE TRUE, COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY FALSE STATEMENTS
OR FACTUAL OMISSIONS FROM THIS FORM MAY BE HELD AGAINST MY CANDIDATURE AND/OR MAY PROVIDE
GROUNDS FOR DISCIPLINARY/LEGAL ACTIONS.

DATE SIGNATURE

Note: The information you give on this Personal History Form will be used by KRA and any external recruitment consultant
and/or organisation appointed by us to help with the recruitment process. The information inrelation to your application
and this recruitment process will be held on both electronic and paper format.

KRA does not charge any fee for in connection with the recruitment or the application process.