Online Job Application COUNTY GOVERNMENT OF KAKAMEGA COUNTY PUBLIC SERVICE BOARD APPLICATION FOR EMPLOYMENT FORM Please complete this form in BLOCK letters as appropriate and submit to the Secretary County Public Service Board, P.O BOX 458-50100 Kakamega, Kenya, or apply online Tel: +254 020-2000520, 0718754093 Email: firstname.lastname@example.org 1. Vacancy Applied For Vacancy/Post*Vacancy No.*Department*Agency 2. Personal Details Name* Surname First Name Other Names Nationality*ID NO*Employment/ P NoDate of Birth* Gender*MaleFemaleAddress*Postal Code*Home County*Sub County*Ward*TelephoneMobile*Email Address* Alternative contact person*Telephone* 3. Other Details Indicate the language(s) you are proficient in*Do you suffer from any physical impairment?*YesNoGive Details of the impairmentHave you been cleared by the following agencies? (Tick where appropraite)* EACC CID HELB KRA Have you ever been convicted of any criminal offences or a subject of probation order?*YesNoHave you ever been dismissed or otherwise removed from employment?*YesNoState reason(s) for dismissal/removalHave you ever been interviewed by the County Public Service Board of Kakamega before?*YesNoState the postInterview date (Declaring the above information will not necessarily debar an applicant from employment in Public Service. Each case will be considered on its own merit ) 4. Academic/ Professional/ Technical Qualifications (Starting with the Highest) *Year (From - To)University/ College/ Institution/ SchoolAward/ Attainment (e.g Degree, Diploma, Certificate)Courses (e.g PhD, Msc, BA)Subject (Econ, Maths e.t.c)Class/ Grade 5. Other Relevant Courses and Training/ Registration/ Membership to Professional Bodies/ Institution *YearInstitution/ CollegeCoursesDetails 6. Employment Details (starting with the most recent) Year (From - To)Employer's NamePosition/ Rank/ DesignationJob Group/ Gross Monthly Salary (Ksh.)Terms of Service (e.g contract, permanent) Briefly state your current duties, responsibilities and assignmentsPlease 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* 7. Personal References The names of distinguished persons should not be used unless they really know you. The names of members or staff of the County Public Service Board should also not be used.1. Full Name*Organization/Company*Occupation*Address* Address Line 2 Phone*Email* Period for which he/ she has known you*2. Full Name*Organization/Company*Occupation*Address* Address Line 2 Phone*Email* Period for which he/ she has known you*3. Full Name*Organization/Company*Occupation*Address* Address Line 2 Phone*Email* Period for which he/ she has known you* 8. Attachments: Attach your documents and certificates Drop files here or 9. 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 actionDate Attach a scanned copy of your signaturePhoneThis field is for validation purposes and should be left unchanged.