CENTENARY BANK HEAD OFFICE

Application for Employment Form

Please read through carefully and complete this form as accurately and as truthfully as possible. All

questions must be answered. Failure to provide full and accurate information will lead to disqualification.
Please note that only shortlisted candidates will be contacted.

1. Date of advert.………………………………………………………………………………
2. Post applied for? ………………………………………………………………………
3. Surname at Birth /Maiden name …………………………………………………….………
4. Surname Now …………………………………………………….……………………….
5. First/ Other Names………..………………………………………………………………
6. Date of birth DD/MM/YY ……………………………… Age……………………………
7. Gender (tick) Male Female

8. Denomination (Religion); Catholic Protestant/Anglican Pentecostal Seventh Day Adventist

Orthodox Atheist Moslem Other (Pls specify) .....…………………………………

9. Marital Status (tick as appropriate)

Never Married Married Divorced/Separated Single Widow/widower
10. Full Residential address (Suburb/Zone/village) ………………………………………………
11. Town/City/District……………………………………………………………………………
12. Full Postal Address ……………………………………………………………………………
13. Contact Telephone number(s) ……………………………Home Tel No…………………
14. Contact Email Address. ………………………………………………………………….…
15. Are you a citizen of Uganda? .................., If not, indicate current citizenship………………
16. Passport Number………………………… ID Number …………..…………………………..
17. Home District. ………………………………………………………………………………
18. Summary of previous employment record (in descending chronological order, including present
employment)
Year(s)/date(s) Employer Current New Salary Position(s) held Reasons for
Salary Expectation leaving/or
(dd/mm/yy)
(gross) UGX (gross) UGX current intention to
leave.
From To

This document has been classified as CONFIDENTIAL - EXTERNAL by Centenary Bank.

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 19. Duration of unemployment in the past 10 years (indicate start and
dates)……………………………………………………………………………………………………….
20. Duration and Nature/type of self-employment in the past 10 years (state nature of self-
employment)………………………………………………………………………………
21. Notice required on resignation (enter 0 if none is required)………………………
22. Have you ever worked with Centenary Bank before? Yes……No……… When?...........................position held
………………………………………………….…..
23. When we check with all your past employers, whether right or wrong, how many of them will say you were
fired from the job?.............................................................................................................................
24. List each job (lost) and explain what happened?..............................................................................................
………………………………………………………………………………………………………………………
……………………………………………………………………………….……….....................
25. Have you ever been a subject of Disciplinary hearing? If yes explain what happened?
..........................................................................................................................................
26. Basic Education (highest level attained)………………………………………………………
27. Student Index Number (Degree/Diploma level)……………………………………………..
28. Indicate Award or class of Degree/Dip (as applicable) …………………………………….
29. Institution/ year when awarded …………………………………………………………
30. Other Qualifications…………………………………………………………………………
31. Any sports, clubs or honours?..................................................................................
32. Languages spoken (please tick as appropriate to indicate competence level)
Language Fluent Can make myself Inadequate Read Write
understood

33. Medical and Physical data

 Are you willing to take a physical examination for this position? Yes……… No…..
 Do you have any medical condition (Yes/No). if yes, pleas clarify…………………………………….
 Are you currently taking any medication? Yes……… No…………………………………………….
 If yes, specify the medication and indicate the reason...........................................................................

34. Financial Information

 Do you have a running loan with a Bank or Financial Institution/Individual?………………………
 How much money would be required to settle all your outstanding debts?.......................
 In the past 5 years how many times have you:
a. Defaulted on a loan or bill?.........................................................................................
b. Had deductions taken from your pay by Government /Courts?...................................
c. Been declared bankrupt?...............................................................................................
This document has been classified as CONFIDENTIAL - EXTERNAL by Centenary Bank.
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 d. Had to appear in court due to bad debt?..................................................................
e. Been threatened with a law suit due to bad debt?...................................................
f. If yes, please clarify………………………….. ………………………………………………………….
35. Alcohol
 Do you drink Alcohol?
 Have you ever been disciplined because of alcohol?
 Have you ever lost employment due to alcohol?
 Have you ever been treated for alcohol abuse?
36. Security - Have you ever (been):
i. Arrested before for an alleged Crime? (Yes/No). OR Released on Bond (Yes/No)
ii. Threatened with arrest by any third party? (Yes/No)
iii. Served with sermons in a criminal/civil case? OR Appeared in court as a suspect? (Yes/No)?
iv. Convicted by a competent Court for a Crime? (Yes/No)
v. Sent to jail for any reason? (Yes/No)
vi. Participated in or committed a Fraud (electronic or traditional, forgery)? (Yes/No)
vii. Facilitated or Abetted Fraud/forgery or Falsification of academic documents, etc.. (Yes/No)
(If Yes, please explain)..........................................................................................................................
 REFEREES (must be competent to recommend a candidate and Not Relatives or Spouses):
1. Name:…………………………………………… Tel…………………………………………………....
Postal address:………………………………….. Email………………………………………………….
Position………………………………………… Organization/Employer……………………………….
2. Name:…………………………………………… Tel……………………………………………………..
Postal address:………………………………….. Email……………………………………………………
Position………………………………………… Organization/Employer………………………………….
3. Name:…………………………………………… Tel…………………………………………………….….
Postal address:………………………………….. Email………………………………………………..……
Position………………………………………….. Organization/Employer………………………………..…
4. Present Employer (Particulars of HR contact person)…………………………………………………………..
Name:……………………………………………..Tel…………………………………………………………..……
Postal address:……………………………………..Email…………………………………………………………..…
Position…………………………………………….Organization/Employer………………………………………….
5. Names and Tel contacts of two friends ..………………………………………………………………………
40. Applicant’s Declaration: I hereby declare that the information given on this form is true and accurate to the best of my
knowledge and belief: Tick items you have attached (a) Application letter (b) Detailed CV (c) Certified Copies of Certificates
(d) Letters of Reference

Statement of Consent: “I…………………………….. sign……………………………here by consent that the organization or

its agent may verify the information provided by me in this form. I shall willingly and promptly provide any required additional
clarification or additional information on any matter stated in this form in the process of verification”
Name & Signature of Applicant:……………………… ………………………/.………………Date:………………

Thank You for Your Cooperation; being one of the many applicants being considered for this position.
This document has been classified as CONFIDENTIAL - EXTERNAL by Centenary Bank.
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