MCPSB.
2022
REPUBLIC OF KENYA
GOVERNMENT OF MACHAKOS COUNTY
COUNTY PUBLIC SERVICE BOARD
EMPLOYMENT APPLICATION FORM
Instructions
Please fill this form clearly and completely
1. Vacancy Applied
Vacancy/Post:………………………………………………………………………………………………………………………………………..……………………………………………….……………………..
Department: …………………………………………………………………………………………………………………………………………………………………………………………………………………
2. Personal Details
Name of applicant: ……………………………….………………………. …………..………….…..……..…………………….. ………………………………………………………………...
(Surname) First Name Other Name(s):
Title: ……………………
(Mr./Mrs./Miss/Ms.)
Date of Birth: …………………………….…………….………..…. Gender: Male Female
(DD-MM-YYYY)
Nationality: ……………………..………………… ID No/Passport No: ……………………… Employment/PNo: …………………………..…..…………………
Address: …………………………………………… Postal Code: ………..………………………..
Home County: ………………………………... Sub County: ……………………………………. Ward: .…………………………….………….…………..........................
Telephone: …………………………………… Mobile: ………………………………………… E-mail address: ………………….…….………………….….............
Alternative contact person: ……….………………........................................................... Telephone: ………………………………………………………………………..……………
3. Other Details
Indicate the language(s) you are proficient in……………………………………………………………………………………………………………………………………………………
Do you suffer from any physical impairment? Yes No
If yes, give details:……………………………………………………………………….……………………………………...……………………………….…………………………………………….
Have you ever been convicted of any criminal offences or a subject of probation order? Yes No
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)
4. Academic /Professional/Technical Qualifications (Starting with the Highest)
Year Institution/School Award/Attained Courses
From To (e.g. Certificate/Grade)
5. Other Relevant Courses and Training /Registration/Membership to Professional Bodies/Institution Relevant
Courses and Training /Registration/Membership to Bodies/Institution
Year Institution/College Courses Details
6. Employment Details (starting with the most recent)
Year Employer’s Name Position/ Job Group / Gross Monthly
From To Rank/Designat ion Salary(Kshs.)
7. Briefly state your current duties, responsibilities and assignments
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8. 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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Personal References
The names of distinguished persons, relatives and names of members of staff of the Machakos County Public Service Board should not be used.
1. Full Name:……………………………………………………………………………..………………………………………………………………………..…..…………………………………………..
Address:…………………………………………………………………………………………..………………………………………………………………….………………………………………….
Telephone No: ……………………………………………………...…………… E-mail address:……………………………………………………………....................................................
Occupation:…………………………………………………………………..…………………………...…………………………………………………………………….…………………………….
Period for which he/she has known you: ………………………………………………………..……………………………………………………………………………………………………
2. Full Name:…………………………………………………………………………………..……..……………………………………………………………………………..……………………………..
Address:…………………………………………………………………………………………..……………………………………………………………………………………………………………..
Telephone No: …………………………………………,,,,,,,,,,,,………………… E-mail address:…,,,,…………………………………………………….....................................................
Occupation:…………………………………………………………………………………...……………………………,,,,,,,,,,,,,,,……………………………………….…………………………….
Period for which he/she has known you: ………………………………………..……………………………….…………………………………………………………………………………
Declaration:
I hereby certify to the best of my knowledge that the particulars given on this form are correct and I understand that any incorrect
information may lead to disqualification/legal action.
Date: ………………………………………….. ………………………………………..
(DD-MM-YYYY) Signature of the Applicant
