Fillable Printable National Police Recruitment Application Form (2015)

National Police Recruitment Application Form (2015)

National Police Service Commission. Application Form , 2015

NATIONAL POLICE SERVICE COMMISSION

POLICE RECRUITMENT APPLICATION FORM

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Please fill the form in neat BLOCK letters

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Do not leave any section blank, sections that do not apply should be marked N/A

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Submit dully completed forms to the recruitment panel at the National Police Service Recruitment Center on

the recruitment date (20

April 2015).

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

(Surname) (First Name) Other Name(s)

Title: ……………………………………….………. Gender: Male Female

(Mr/Mrs/Miss/Ms)

Nationality ………………..……………………….. ID/NO: ……………………………………………...

Tribe ……………………………………………….

County …………………… Sub-County…………………………… Constituency ……………………….…

Division …………………. Location ……………………..………… Sub-Location ..……………….……….

Date of Birth ………………………………………. Place of Birth ……..……………………...…………

(dd-mm-yyyy)

Age ……………………. Weight (kgs) ……………………. Height ……………………

Physical Address …………………………………………………………………………………………………

Telephone Number: ……………………………………………………………………………………………...

Email Address (if applicable) ……………………………………………………………………………………

Position Applied For: ………………………………

Service Preference: Kenya Police Service Administration Police Service

General Service Unit

SECTION 1 : POSITION APPLIED FOR AND PERSONAL DETAILS

National Police Service Commission. Application Form , 2015

Alternate Contact person

Name …………………………………………………… Relation: …………………………………………….

Physical Address (if applicable): ………………………………………………………………………………..

Telephone Number: ……………………………………………………………………………………………...

Email Address (if applicable): …………………………………………………………………………………...

School/ College

/University/

Institution e.t.c

Duration

Award / Attainment

(Degree, diploma,

certificate )

Course

Undertaken

Grade

Attained

From

Employer’s name

Duration

Position Held

Monthly gross salary

From

SECTION 3: EDUCATIONAL BACKGROUND (starting with the highest)

SECTION 4: EMPLOYMENT HISTORY (starting from the recent)

National Police Service Commission. Application Form , 2015

Tick on the box provided where applicable

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)

Do you have any criminal charges pending and/or awaiting hearing in court?

Yes No

Have you ever been convicted of any criminal offence?

Yes No

If yes please tabulate in the table below:

Offence

Year of Conviction

Detail of fine/

supervision/Imprisonment

Do you have an injury or psychological or medical condition, disease or infection (e.g. hearing loss) or any

other disability, which may affect your ability to perform the duties of the position satisfactorily?

Yes No

If yes, please provide details and describe any facilities, technical aids, equipment or adaptations to the

workplace that you would require to satisfactorily carry out the duties of this position.

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

SECTION 5: DISCIPLINARY/CONVICTIONS

SECTION 6: HEALTH HISTORY

EMPLOYMENT HISTORY

National Police Service Commission. Application Form , 2015

Please indicate the name, position and telephone numbers of THREE people you would like to nominate as

referees in support of your application (e.g. chief, the principal of your immediate former school,

recognized professional). The referees will need to be able to talk to us about your suitability for this

position. Referees may be contacted at any time after the short-listing phase.

(By signing the declaration at the end of this application form you are authorizing the Commission to

contact these referees and acknowledging that the information they provide will be supplied in confidence

as evaluative material.(the persons nominated must not be a relative).

Name of Referee

Referee’s phone

number

Position Held by Referee

Relationship to Applicant

Indicate the language(s) you are proficient in …………………………………………………..….…………...

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:

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SECTION 7: REFEREE CHECK

SECTION 8: ADDITIONAL INFORMATION

National Police Service Commission. Application Form , 2015

 I declare that the information given in this application is true and complete to the best of my

knowledge and information.

 I acknowledge the purpose of this application form and the material associated with it is to assist in

assessing my suitability for the position I am applying for.

 I authorize the selection panel to contact the referees I have nominated above seeking verbal and/or

written information for the purposes of validating my suitability for the position I am applying for.

 I understand that the information provided to the selection panel by my referees is supplied in

confidence as evaluative material and will not be disclosed to me.

 I acknowledge that if I give any incorrect or misleading information or if I have omitted any

information during the appointment process, I may be disqualified from consideration or, if

appointed and this is subsequently discovered, I may be liable for dismissal.

 I understand that under section 25 of the NPSC Act, any person who willfully gives to the

Commission any information which is false or misleading in any material particular, commits an

offence and shall on conviction be liable to a fine not exceeding two hundred thousand Shillings or

to imprisonment for a term not exceeding two years or to both.

Signed: ___________________________ Date: _______________________

DECLARATION