(b) Have you ever been convicted on any charge in a court of law?

Yes/No
If the answer is “YES’’, give the following particulars; TSC/APPT/1
A0024872
(i) Offence for which convicted …………………………………………………………………
(ii) Date and place of conviction ………………………………………………………………
(iii) Sentence(s) imposed …………………………………………………………………
Note: the fact of an applicant declaring that he has been convicted of an offence will not debar
him from employment by the Teachers Service Commission. Each case will be considered on its TEACHERS SERVICE COMMISSION OF KENYA
own merit having regard to the nature and circumstances of the offence. APPLICATION FOR EMPLOYMENT
(c) Have you ever, with or without being convicted, been made subject of a probation order?
…………………………………………………………………………………………………….. Section A: Important Notes for Applicants
1. All sections of this form MUST be completed in full.
10. Break in the service, if any:
2. Only ONE copy of the form in the applicant’s own handwriting should be submitted to the Secretary.
From…………………………………………..To………………………………………………….. Teachers Service Commission, Private Bag, 00100 Nairobi, Kenya
From…………………………………………..To………………………………………………….. 3. Please forward the following:
Reasons for break in service (e.g. resignation, further education, dismissal, imprisonment, retirement, (a) Duly certified Photostat of:-
etc) (i) National Identification card (both sides) or passport.
……………………………………………………………………………………………………….. (ii) Academic and professional certificates and testimonials.
(b) GP 69 Form from a government doctor.
………………………………………………………………………………………………………..
(c) Two recently taken passport size photographs from a studio (NOT PHOTO ME MACHINE).
11. Do you have any form of permanent disability? Yes/No. 4. In case of new applicant documentary proof of previous service should be attached to the application
If so, state the nature of disability……………………………………………………………………. form. Photostat or certified copies of service will be accepted by the commission.
……………………………………………………………………………………………………….. 5. If you are invited for an interview by the teachers service commission, you MUST bring the originals
12. Personal references: of your academic certificates and testimonials with you, but make sure that they are returned to you
Give the names, addresses and status of two persons (not related to you) to whom reference can be after the interview.
made; 6. It is an offence for a person to falsely or fraudulently hold himself or herself out to be a registered
teacher or submit false or misleading information or make false misrepresentation to or knowingly
a) ……………………………………………………………………………………………………
mislead a member or staff of the Commission. Such an offence will be punishable upon conviction to
…………………………………………………………………………………………………… a fine not exceeding KSh. 100,000/= or to imprisonment for a term not exceeding 12 months or both
b) …………………………………………………………………………………………………… (section 44 (1)(b) and 2(b) and (c) of the Teachers Service Commission Act, No. 20 of 2012.
……………………………………………………………………………………………………
Section B: Applicant’s Details
13. I herby certify that: 1. Vacancy for which the application is made…………………………………………………………………
(a) I do not suffer from any pecuniary embarrassment.
Name of Institution………………………………………………………………………………………….
(b) The particulars furnished on this form are correct to the best of my understanding and knowledge.
County ……………………………………………Sub-county…………………………………………….
Date:……………………………………… …………………………………………….
Signature of candidate 2. (a) Full Names ………………………………………………………………………………………………
Section C: Recommendation of an Approved Officer and/or Agent of the commission. (BLOCK CAPITALS, STATE WHETHER MR., MRS. OR MISS, ETC)
(To be completed in cases where an application is submitted through an approved agent of the Maiden name if married woman (name before marriage)
Commission).
……………………………………………………………………………………………………………
…………………………………………………………………………………………………………
………………………………………………………………………………………………………… (b) Religion ………………………………………………………………………………………………….
………………………………………………………………………………………………………… (c) Permanent Address ……………………………….. Postal Code ………………………………………
Date…………………………………….. …………………………………………… Contact Address …………………………………………………………………………………………
Signature of Approved Officer / Agent
(d) Telephone Number(s) …………………………………………………………………………………..
Address …………………………………..
…………………………………………… (e) Date of Birth …………………...…………….Age……………………………………………....Years
…………………………………………… (f) Place of Birth ……………………………………………………………………………………………
(g) Home County………………………………………Sub-county………………………………………..
GPK (L)630-26m-2/2020 (h) TSC Number…………………………………………………………………..(if previously registered)

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 6. Teaching subjects:
3. State if you are a Kenyan citizen; (a) Major subject(s) studied (b) Minor subject (s) studied
(a) *By Birth ……………………………… (give ID./No)……………………………………….. …………………………………. …………………………….……………
(b) By registration ……………………… (give certificate No.) ………………..………………. …………………………………. …………………………….……………
7. Additional qualifications (state full details in respect of qualifications or courses attended, games,
*Delete whichever is applicable. community work, etc).
If not a Kenyan Citizen, state nationality ……………………………………………………… ………………………………………………………………………………………………………
Alien/Passport No. …………………………………………………………………………….. ………………………………………………………………………………………………………
4. Present employment: ………………………………………………………………………………………………………
(a) Name of Employer …………………………………………………………………………….. ………………………………………………………………………………………………………
Address if not by TSC………………………………………………………………………….. ………………………………………………………………………………………………………
8. Experiences:
(b) Present grade or status ………………………………………………………………………….
(a) Teaching experience
(e.g. P1, S1, Assistant Lecturer, Senior Lecturer, Graduate Teacher, Headmaster, Principal, NAME AND TYPE OF COUNTY/SUB-COUNTY GRADE (E.G. P1, S1, EXACT PERIOD OF
etc.) SCHOOL ASST, LECT, H/M. SERVICE
(c) Date of Appointment to present grade ………………………………………………………….. ETC
FROM TO
Present Annual Salary KSh. …………………………………..per year.
(d) Details of duties …………………………………………………………………………………
…………………………………………………………………………………………………...
…………………………………………………………………………………………………...
…………………………………………………………………………………………………...

5. Educational and Professional Qualification:

DATE STANDARD OR
EDUCATION NAME OF INSTITUTION CERTIFICATE OR
FROM TO DEGREE
(a) Primary

(b) Non-Teaching experience

NAME OF EMPLOYER EXACT NATURE OF DUTIES EXACT PERIOD OF SERVICE

FROM TO

(b) Secondary /Technical

(c) College

9. (a) Have you ever been dismissed or otherwise removed from Government, other public service or
the Teaching service?
……………………………………………………………………………………………………..
If so, give details …………………………………………………………………………………..
……………………………………………………………………………………………………...
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