NRK-CPSB (2) (REVISED 2021)

REPUBLIC OF KENYA

NAROK COUNTY PUBLIC SERVICE BOARD

APPLICATION FOR EMPLOYMENT FORM

Please complete all sections of this form as appropriate in BLOCK letters and submit to the Secretary, County Public Service
Board, P.O.BOX 545, 20500 NAROK, KENYA.

1. Vacancy Applied For

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

Ministry:…………........................……………………………................................. State Department:………………..……………………....................

2. Personal Details of the Applicant

Name: ……………………………….….....………..………….…..……..… ……………………………… ...... Title:……………………

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

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

(dd-mm-yyyy)

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

Sub County ............................................................Constituency: ............................................................Ward...................................................................

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

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

Name of alternative contact person:…….…………………......................................................Telephone No:……………………………........................

Are you living with a disability? Yes No

If yes, give;
(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 (dd-mm-yyyy).......………..........................................................................

Upgraded post (where applicable):……………………………………………effective date of previous appointment:…………………………….........

(dd-mm-yyyy)

On Secondment (where applicable):Organisation:....................................................... Designation:............................................. Job Group/Grade:..........

Other, Please specify:
Terms of Service: Permanent & Pensionable Contract .........................................................

4. All other Applicants

Current employer (where applicable):………………………………….............Position held:………....……..............……………...............................

Effective date: ……………….………….........................Gross Salary (monthly)
Ksh.…………………………………………………......................... (dd-mm-yyyy)
Our E-mail: [email protected]
5. Other Personal Details

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

If Yes, state nature of offence, the 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)

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

6 Academic Qualifications. (Starting with the Highest)

Award/Attainment
Course/Programme Specialization/Subject
University/ (e.g. Masters,
Year (e.g. PhD, MSc, BA, (e. g Econ, Maths, Class/Grade
High School Bachelors, Degree,
O’Level) Sociology e.t.c)
KCSE)
From To

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

ademic /Professional/Technical Qualifications Relevant to the post. (Starting with the Highest)
Year Specialization/Subject
Award/Attainment
(e. g Human Resource,
Institution (e.g. Higher Diploma, Diploma, Class/Grade
Engineering, Counselling
From To Certificate)
e.t.c)

8 Relevant Courses and Training attended Lasting not Less than One (1) Week

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

Our E-mail: [email protected]

9. Current Registration/Membership to Professional Bodies

Membership type (e.g. Date of Renewal

Professional Body Membership/Registration No.
Associate, Full etc)

10. Employment Details - where applicable (starting with the current or most recent)
Job Group/Grade
Designation/ Position /Scale Ministry/State Department/
Year
Gross Monthly Salary Institution/ Organization
(Ksh.)
From To
(dd-mm- (dd-mm-
yyyy) yyyy)

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

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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.

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Our E-mail: [email protected]
13. Referees (people who have interacted with you professionally)

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

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

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

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

Period for which the referee has known you:………………………………………..……………………………………………………........................

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

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

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

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

Period for which the referee has known you:……………………………………………………………….…………………………………….……......

13. Declaration

I certify that the particulars given on this form are correct and understand that any incorrect /misleading information may lead to
disqualification and/or legal action.

Date: ……………………………. ……………………………..

(dd-mm-yyyy) Signature of the Applicant

Our E-mail: [email protected]