Form - Application For Employment.2021 1

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NATIONAL ENVIRONMENT MANAGEMENT AUTHORITY (NEMA)

APPLICATION FOR EMPLOYMENT FORM


Please complete all sections of this form as appropriate in BLOCK letters
Information provided in this form will be treated with the utmost confidentiality.

1. Vacancy applied for ………………………………………………………………………………………………………………..

2. Personal Details of the applicant

Surname First Name Middle Name Title (Mr., Ms, Mrs.,


Dr., Prof etc.)

Date of Birth ID/PP No. KRA Pin No Nationality Home County Gender
(DD/MM/YYYY
)

Tel. /Mobile No. Postal Address Email Marital Status

Name of Alternative Contact Tel. No.


Person

Are You Living with Disability? If Yes State Registration Number & Nature of Disability
Date with National Council For

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(Yes/No) Persons With Disability

3. Other Personal Details

Have you ever been convicted in a court of law?

Yes No.

If yes, state the nature of offence, the year and duration of conviction

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

……………………………………………………………………………………………………………………………………………………….

Have you ever been dismissed or otherwise removed from employment?

Yes No

If yes, state reasons for dismissal/removal

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

Effective date……………………………………………………………………………………………………………………………….

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

4. Academic Qualifications (Starting with the Highest)

Year University/High Award/Attainment Specialization/Subject Class/


School (e.g. PhD, Masters, (E.G. Econ, Maths, Grade
Bachelors, Post Sociology Etc.)
Graduate Diploma,
Diploma, KCSE)

FROM TO

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5. Professional/Technical/Certifications Relevant to the post (Starting With The Highest)

YEAR Institution Award/attainment Specialization/Subject Class/


(e.g. Higher Diploma, (e.g. Human Resource, Grade
Diploma, certificate) Engineering,
Counselling etc.)

FROM TO

6. Relevant Courses And Training Lasting Not Less Than One (1) Week

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

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7. Current Registration/Membership to professional Bodies
Professional Body Membership/Registration Membership type (e.g. Date of
No. Associate, Full etc.) Renewal

8. Employment Details – Where applicable (starting with the current or most recent)
Year Designation/Position Job Group/Grade/scale Institution/Organization
Gross Monthly Salary (Kshs.)

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

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

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

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

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

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

10. 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 recent achievements and your
reason for applying for this post.

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

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

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

11. Referee (People who have interacted with you professionally)

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

Occupation ……………………………………………………………………………………………………………………………………

Address……………………………………… Post Code………………………………………City/Town…………………………

Mobile No……………………………………..Email address…………………………………………………………………………

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

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

Occupation ……………………………………………………………………………………………………………………………………

Address……………………………………… Post Code………………………………………City/Town…………………………

Mobile No……………………………………..Email address…………………………………………………………………………

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

3. Full Name ………………………………………………………………………………………………………………………………………

Occupation ……………………………………………………………………………………………………………………………………

Address……………………………………… Post Code………………………………………City/Town…………………………

Mobile No……………………………………..Email address…………………………………………………………………………

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

12. 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……………………………………………………… Signature of the applicant………………………………………………….

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