Recruitment Application Form

Police
REPUBLIC OF KENYA
RECRUITMENT APPLICATION FORM

 Please fill 2 copies of this form in neat BLOCK letters
 Do not leave any section blank, sections that do not apply should be marked N/A
 Submit dully completed forms to the recruitment panel at the National Police Service Recruitment Center on
the recruitment on the date of the recruitment exercise 2021..
SECTION 1 : PERSONAL DETAILS
Name of applicant: ……………………………….…. …………..………….…..……..… ……………………

(Surname) (First Name) Other Name(s)
Title: ……………………………………….………. Gender: Male Female

(Mr/Mrs/Miss/Ms)
Nationality ………………..……………………….. ID/NO: ……………………………………………...
Tribe ……………………………………………….
The following details should be entered exactly as they appear on your ID.
County …………………… Sub-County…………………………… Division ………………….
Location ……………………..………… Sub-Location ..……………….……….
Recruitment Centre……………………………….. Constituency of Recruitment…………………………
Date of Birth ……………………………………….

(dd-mm-yyyy)
Age ……………………. Weight (kgs) ……………………. Height ……………………..
Current Physical Address…………………………………………………………………………………………
Mobile Number: ……………………………………………………………………………………………........
Email Address: ………………………………………………………………………………………………….
Form, 2021 1
Alternate Contact person
Name …………………………………………………… Relation: …………………………………………….
Physical Address: ……………………………………………………………………………………..............
Mobile Number: ……………………………………………………………………………………………....
Email Address: …………………………………………………………………………………......................
SECTION 2: EDUCATIONAL BACKGROUND (starting with the highest)
School/ College Duration Award / Attainment Course Grade

/University/ (Degree, diploma, Undertaken Attained
Institution e.t.c certificate )
From To
SECTION 3: EMPLOYMENT HISTORY (starting from the recent)
Employer’s name Duration Position Held Monthly gross salary
From To
Form, 2021 2
SECTION 4: DISCIPLINARY/CONVICTIONS
Tick on the box provided where applicable
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)
Do you have any criminal charges pending and/or awaiting hearing in court?
Yes No
Have you ever been convicted of any criminal offence?
Yes No
If yes please tabulate in the table below:
Offence Year of Conviction Detail of fine/

supervision/Imprisonment
SECTION 5: MEDICAL HISTORY
Do you have an injury or psychological or medical condition, disease or infection (e.g. hearing loss) or any
other disability, which may affect your ability to perform the duties of the position satisfactorily?
Yes No
If yes, please provide details and describe any facilities, technical aids, equipment or adaptations to the
workplace that you would require to satisfactorily carry out the duties of this position.
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
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……………………………………………………………………………………………………………………
Form, 2021 3
SECTION 6: REFEREES
Please indicate the name, position and telephone numbers of THREE people you would like to nominate as
referees in support of your application (e.g. chief, the principal of your immediate former school,
recognized professional). The referees will need to be able to talk to us about your suitability for this
position. Referees may be contacted at any time after the short-listing phase.
(By signing the declaration at the end of this application form you are authorizing the Commission to
contact these referees and acknowledging that the information they provide will be supplied in confidence
as evaluative material.(the person(s) nominated must NOT be a relative).
Name of Referee Referee’s phone Position Held by Referee or

number Relationship to Applicant
1
SECTION 8: ADDITIONAL INFORMATION
Indicate the language(s) you are proficient in …………………………………………………..….…………...
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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….………………………………………………………………………………………………………………
……….…………………………………..…………….…………………………………………………………
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Form, 2021 4
DECLARATION
 I declare that the information given in this application is true and complete to the best of
my knowledge and information.
 I acknowledge the purpose of this application form and the material associated with it is to assist
in assessing my suitability for the position I am applying for.
 I authorize the selection panel to contact the referees I have nominated above seeking verbal
and/or written information for the purposes of validating my suitability for the position I am
applying for.
 I understand that the information provided to the selection panel by my referees is supplied
in confidence as evaluative material and will not be disclosed to me.
 I acknowledge that if I give any incorrect or misleading information or if I have omitted
any information during the appointment process, I may be disqualified from consideration or, if
appointed and this is subsequently discovered, I may be liable for dismissal.
 I understand that under section 25 of the NPSC Act, any person who willfully gives to
the Commission any information which is false or misleading in any material particular,
commits an offence and shall on conviction be liable to a fine not exceeding two hundred
thousand Shillings or to imprisonment for a term not exceeding two years or to both.
PLEASE ATTACH THE FOLLOWING DOCUMENTS TO EACH APPLICATION FORM:-
1. Copy of your ID.

2. Copy of your Secondary School Leaving Certificate.
3. Copy of your KCSE (and other academic certificates if any).
4. Copy of your birth certificate.
Signed: Date:
Form, 2021 5

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Police

SECTION 1 : PERSONAL DETAILS

Name of applicant: ……………………………….…. …………..………….…..……..… ……………………

Title: ……………………………………….………. Gender: Male Female

Nationality ………………..……………………….. ID/NO: ……………………………………………...

County …………………… Sub-County…………………………… Division ………………….

Location ……………………..………… Sub-Location ..……………….……….

Recruitment Centre……………………………….. Constituency of Recruitment…………………………

Date of Birth ……………………………………….

Age ……………………. Weight (kgs) ……………………. Height ……………………..

Current Physical Address…………………………………………………………………………………………

Mobile Number: ……………………………………………………………………………………………........

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

Name …………………………………………………… Relation: …………………………………………….

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

Mobile Number: ……………………………………………………………………………………………....

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

SECTION 2: EDUCATIONAL BACKGROUND (starting with the highest)

School/ College Duration Award / Attainment Course Grade

SECTION 3: EMPLOYMENT HISTORY (starting from the recent)

Employer’s name Duration Position Held Monthly gross salary

Tick on the box provided where applicable

If Yes, State reason (s) for

Have you ever been convicted of any criminal offence?

If yes please tabulate in the table below:

Offence Year of Conviction Detail of fine/

SECTION 5: MEDICAL HISTORY

Name of Referee Referee’s phone Position Held by Referee or

SECTION 8: ADDITIONAL INFORMATION

Indicate the language(s) you are proficient in …………………………………………………..….…………...

PLEASE ATTACH THE FOLLOWING DOCUMENTS TO EACH APPLICATION FORM:-

1. Copy of your ID.

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