Fillable Printable National Police Recruitment Application Form (2015)
Fillable Printable National Police Recruitment Application Form (2015)
National Police Recruitment Application Form (2015)
National Police Service Commission. Application Form , 2015
1
NATIONAL POLICE SERVICE COMMISSION
POLICE RECRUITMENT APPLICATION FORM
Please fill the form in neat BLOCK letters
Do not leave any section blank, sections that do not apply should be marked N/A
Submit dully completed forms to the recruitment panel at the National Police Service Recruitment Center on
the recruitment date (20
th
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
2
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
To
Employer’s name
Duration
Position Held
Monthly gross salary
From
To
SECTION 3: EDUCATIONAL BACKGROUND (starting with the highest)
SECTION 4: EMPLOYMENT HISTORY (starting from the recent)
National Police Service Commission. Application Form , 2015
3
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
Y
EMPLOYMENT HISTORY
National Police Service Commission. Application Form , 2015
4
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 needtobe 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 inconfidence
as evaluative material.(the persons nominated must not be a relative).
Name of Referee
Referee’s phone
number
Position Held by Referee
or
Relationship to Applicant
1
2
3
Indicate the language(s) you are proficient in …………………………………………………..….…………...
Please give details of yourabilities, skills and experiencewhich 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:
………………………………………………………………………………………………………………..…
….………………………………………………………………………………………………………………
……….…………………………………..…………….…………………………………………………………
……………………………………………………………………………………..……………………………
………………………………………………………………………………………………………………..…
….………………………………………………………………………………………………………………
……….…………………………………..…………….…………………………………………………………
……………………………………………………………………………………..……………………………
………………………………………………………………………………………………………………..…
….………………………………………………………………………………………………………………
……….…………………………………..…………….…………………………………………………………
……………………………………………………………………………………..……………………………
………………………………………………………………………………………………………………..…
….………………………………………………………………………………………………………………
……….…………………………………..…………….…………………………………………………………
……………………………………………………………………………………..……………………………
SECTION 7: REFEREE CHECK
SECTION 8: ADDITIONAL INFORMATION
National Police Service Commission. Application Form , 2015
5
I declare that the information given in this application is true and complete to the best of my
knowledge and information.
I acknowledge the purposeof 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 issupplied 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
