FORM ANNEX 5

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SEYCHELLES PUBLIC SERVICE

GOVERNMENT OF SEYCHELLES - EMPLOYMENT APPLICATION FORM

1. POSITION APPLIED FOR

POSITION TITLE EMPLOYER NAME POSITION CODE

2. PERSONAL INFORMATION

Surname: Initials National Identity Number

(Dr/Mr/Mrs/Ms)

First Names:
(tick name normally used)

Surname at Birth: ………………………………………………………… Date of Birth:

Nationality: Country of Birth:

Gender: Residential/Postal Address: Contact Numbers:

Male: Female:

Marital Status

Single: Married: … Divorced:

3. EDUCATION AND TRAINING RECORD

Level/Course:…………………………………………………………….....................................................................................…………………………………

Qualification Obtained: ……………………………………………………………………………………………………………………………………………..

Subjects: ……………………………………………………………………………………………………………………………………………………………

Institute:
Date Entered:
Name:………………………………………………………………………………………………………………………. ………/………./……..

Address: …………………………………………………………………………………………………………………… Date Left:

………/………./………

Level/Course:…………………………………………………………….....................................................................................…………………………………

Certificate Obtained: ……………………………………………………………………………………………………………………………………………….

Subjects: ……………………………………………………………………………………………………………………………………………………………

Institute:
Date Entered:
Name:………………………………………………………………………………………………………………………. ………/………./……..

Address: …………………………………………………………………………………………………………………… Date Left:

………/………./………

Level/Course:…………………………………………………………….........................................................................................………………………………

Certificate Obtained: ………………………………………………………………………………………………………………………………………………

Subjects: ……………………………………………………………………………………………………………………………………………………………

Institute:
Date Entered:
Name:……………………………………………………………………………………………………………………… ………/………./……..
Date Left:
Address: …………………………………………………………………………………………………………………… ………/………./………
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4. LANGUAGES

Language Level and Qualifications (if any)

1. Kreol

2. English

3. French

4.

5.

5. DRIVING LICENCE (S): State Types which you possess: ……………………………………………………………………………………

6. EMPLOYMENT HISTORY

Employing Organisation ………………………………………………………….……………………………………………. Salary Grade:

Address: …………………………………………………………………………………………………………………………. SG: ……………………...

Position Occupied: ……………………………………………………………………………………………………………….

From: …………./……… …/…………… To: ……………/……………./……………….. Gross Salary/year:

Reason for Leaving: …………………………………………………………………………………………………………….. SR: ……………………..

Employing Organisation: ………………………………………………..................…………………………………………… Salary Grade:

Address: ………………………………………………………………………………………………………………………… SG: ……………………...

Position Occupied: ……………………………………………………………………………………………………………….

From: …………./……… …/…………… To: ……………/……………./……………...... Gross Salary/year:

Reason for Leaving: ……………………………………………………………………………………………………...……… SR: ……………………..

Employing Organisation: ……………………………………………….................……………………………………………. Salary Grade:

Address: ………………………………………………………………………………………………………………………… SG: ……………………...

Position Occupied: ………………………………………………………………………………………………………………

From: …………./……… …/…………… To: ……………/……………./……………….. Gross Salary/year:

Reason for Leaving: …………………………………………………………………………………………………………….. SR: ……………………..

Employing Organisation: ………………………………………………...................……………………………………………. Salary Grade:

Address: ………………………………………………………………………………………………………………………….. SG: ……………………...

Position Occupied: ………………………………………………………………………………………………………………..

From: …………./……… …/…………… To: ……………/……………./……………….. Gross Salary/year:

Reason for Leaving: ………………………………………………………………………………………………………………. SR: ……………………..

7. On what date would you be available to take up employment: ........................./......................../........................

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8. DESCRIPTION OF CAREER
(Please give a concise account of relevant experience and reasons for applying for this post. Use additional sheets if necessary):

9. REFERENCES
(Give Details of two persons in a supervisory position known to you for two years):

Surname: First Names: Contact:

Address: Occupation:

Surname First Names: Contact:

Address: Occupation:

May we contact? (a) Your present employer? ………………. (b) Your past employers? …………………………

10. NEXT OF KIN

(Person to be contacted in case of emergency)

Surname National Identity Number:

First Names Contact Numbers:

Address: ……………………………………………………………………………………………………………………………………………….....................

Relationship to applicant: ..................................................................................................................................................................................................................

11. OTHER RELEVANT PARTICULARS

(Describe any special interests)
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12. INTERESTS IN PRIVATE BUSINESS

(Give details)

13. DECLARATION

The facts set forth in this application for employment are true and complete.

Signature: Date: …………/……………/…………….

14. COMMENTS OF PRESENT EMPLOYER

(If applicable)

Name:

Designation:

Signature: ............................................................................... Date: …………/………../………….