NATIONAL

INDUSTRIAL TRAINING AUTHORITY

APPLICATION FORM

SECTION 1: PERSONAL INFORMATION

Surname *(Mandatory) First Name Other Name
*(Mandatory) (Optional)

Sex *(Mandatory) Date of Birth: *(Mandatory)

Male
Female _______ / _______/ _________
Date/Month/Year

Identification Document *(Mandatory) Tick as appropriate

National ID Passport

If National ID enter the ID Number *(Mandatory if ID is selected) ___________________________

Confirm National ID Number *(Mandatory) ______________________________

If Passport enter the passport Number *(Mandatory if passport is selected) ______________________

Confirm Passport Number *(Mandatory) __________________________

County of Residence*(Mandatory) Sub-County of Ward of

Residence*(Mandatory) Residence
*(Mandatory)

Marital Status *(Mandatory)

Single
Married

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Disability

Do you have a disability? *(Mandatory) If you have a disability, what type of

Yes disability? *(Mandatory)
No
Deaf/using sign language

Do you have a card from the National Deaf/able to talk
Council for Persons with Disability (NCPWD)?
*(Mandatory if you have a disability) Blind

Yes No Albinism

Epilepsy


If yes, indicate your NCPWD membership no:
Physical disability
*(Mandatory if you have a NCPWD card)

Mental

Other(Specify) ………………..

Disclaimer: For the last 3 (physical, mental, other):
Does this disability affect your ability to
I acknowledge that if I do not have the NCPWD
card, if the NCPWD does not find me eligible to work? Yes/No *(Mandatory for those who
answer physical/mental/other)
receive a card, or if NITA finds that my disability is
Yes No
not genuine, I will be excluded from the project.


If yes, how? *(Mandatory if answered yes
above)




__________________________

SECTION 2: CONTACT DETAILS

Applicant Contact Information

Email address: Mobile number: (+254) *(Mandatory)

___________________
____________________________
(optional) Confirm mobile number: (+254)
*(Mandatory)

___________________

NITA will communicate with you via SMS. Please
confirm by ticking below checkbox that the mobile

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 number entered is accurate and that the SIM card
will be active throughout. *(Mandatory)
Yes

Do you have a mobile phone? *(Mandatory) Yes No

Alternative Contact

Name of alternative contact person: Mobile number: *(Mandatory) (Should be

*(Mandatory) different from applicant’s phone number)

Relationship to applicant: *(Mandatory). Email address: (optional)

Tick (P) as appropriate.

Father Sister Neighbor
Mother Relative Husband
Brother Friend Wife

3

 SECTION 3: OCCUPATION STATUS
Are you currently in Are you employed? Are you Self-employed (run your
School or College or *(Mandatory) own business? *(Mandatory)
University? *(Mandatory) Yes No Yes No
Yes, high school
Yes, vocational If Yes, what kind of If Yes, for how long?
Yes, college employment? *(Mandatory) *(Mandatory)
Yes, university Unpaid Less than 1 year
No Worker/Work in 1 to 3 years
family business More than 3 years
If No, which year were you last Casual/Daily
in school? Indicate Never if you Wage If Yes, is your business registered?
have never been to school. Part-time *(Mandatory)
*(Mandatory) Full-time Yes No

___________

Are you available for the project
through the next 18 months?
*(Mandatory)
Yes No

SECTION 4: EDUCATION LEVEL

Have you been to If YES, what is your Highest Level of education that you have
school: *(Mandatory) attained:
Yes Please tick ( P ) as appropriate: *(Mandatory if yes is selected)
No
Degree certificate

University Student
Diploma certificate
Diploma/Vocational Student
Form 4 certificate
Secondary but did not reach Form
4
Standard 8 Certificate

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 Primary but did not reach
standard 8

SECTION 5: CONDITIONS
Please tick ( P ) as appropriate: *(Mandatory)

1. Proficiency in ICT. *(Mandatory)
2. Any of the following certificate*(Mandatory)
a) Diploma in Mechanical Engineering;
b) Craft certificate in Welding and Fabrication;
c) Craft Certificate in Production;
d) Government Trade Test II or I;
3. Three (3) years’ experience in
welding*(Mandatory)
Please attach evidence of the above *(Mandatory)

SECTION 6: CONFIRMATION *(Mandatory)

I.........................................................………………(Full name) confirm that the information provided
here above is true and accurate. I accept that the decision made shall be in line with the eligibility
requirements and guided by the operational processes governing the NITA selection process.


Signature..................................................................................... Date....................................
..........................

Date application received: Reference Stamp

number