FORM/RBA/001

RETIREMENT BENEFITS AUTHORITY

APPLICATION FOR EMPLOYMENT

To be submitted in quadruplicate to THE MANAGER, HUMAN RESOURCES,

RETIREMENT BENEFITS Authority P. O. Box 57733, NAIROBI, KENYA The original to
be completed in applicant's own handwriting.

1. Vacancy for which application is made: ………………………………………………

…………………………………………………………………………………………………
…………………………………………………………………………………………………...

2. Full Names: Mr./Mrs./Miss ……………………………………………………………

(BLOCK Capitals, surname first)

Maiden name if married woman: Miss ………………………………………………...

Address: ………………………………………………………………………………..
Telephone Number: ……………………………………………………………………

3. Present employment: …………………………………………………………………

Salary K£ ……………. a year Kshs …………………………………………………..
State whether you are under contract in your present employment: …………………
If so give details ………………………………………………………………………
Telephone Number: ……………………………………………………………………

4. Age: ………………….. and date of birth: …………………………………………….

Candidates who are Kenya citizens should give the following particulars:-
District: ……………………. Location: ………………………………………
Sub-Location: ………………… Village: ……………………………………..
Chief: …………………………… Sub-Chief: ………………………………..

Candidates who are non-citizens should give the following particulars:-

Current Nationality of Nationalities: ………………………………………………

Previous Nationality of Nationalities:

…………………………………………
…………………………………………………………………………………
…………………………………………………………………………………

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 …………………………………………………………………………………
Passport No. …………………………………………………………………...

Periods in Excess of 3 months spent abroad:- …………………………………………

…………………………………………………………………………………………
………………………………………………………………………………………….
Entry Permit No.: ………. Date issued:…….. Valid for ………………………………
…………………………………………………………………………………………
Date of Arrival in Kenya ………………………………………………………………

5. Whether single, married, widow, divorced, separated:…………………………………

Wife's full name (or husband's full name): Mr./Miss: …………………………………
In case of married women, husband's occupation and address: ………………………..

Wife's/husband's nationality at birth and place of birth:………… Place of Birth:…….

Number of Children: …………………………………………………………………...

6. Father/Mother's full name, address and occupation

Mr./Mrs………………………….
Address: ………………………………………………………………………………..

Father's/Mother's nationality at birth: ………………….Place of Birth:……………….

(If dead the above questions should nevertheless be answered, if living, his address
should be given above).

(Personal File No. ……………)

7. School and Colleges in order, mentioning any Name of Headmaster or Date (Month and Year)
distinctions gained in school work, games, etc. Principal
From To
Month Year Month Year
1. …………………………………………………… ………………………………… …… …… …… ……
…………………………………………………… …………………………………
…… …… …… ……
…………………………………………………… …………………………………
2. …………………………………………………… ………………………………… …… …… …… ……
…………………………………………………… ………………………………… …… …… …… ……
…………………………………………………… ………………………………… …… …… …… ……
3. …………………………………………………… …………………………………
…………………………………………………… …………………………………
…… …… …… ……
…………………………………………………… ………………………………… …… …… …… ……
4. …………………………………………………… ………………………………… …… …… …… ……
…………………………………………………… ………………………………… …… …… …… ……
…………………………………………………… …………………………………
5. …………………………………………………… …………………………………
…… …… …… ……
…………………………………………………… ………………………………… …… …… …… ……

8. Give particulars of educational, professional or technical qualifications stating where and when obtained, with
particulars of examinations passe:

1. ……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ……………………………………………………………………………………………………………………
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4. ……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
9. What language(s) do you know?
……………………………………………………………………………………

10. Give full particulars of all your employment since leaving school or college and period of unemployment.
Attach copies (not originals) of available testimonials. IT IS ESSENTIAL THAT THESE PARTICULARS
ARE GIVEN IN FULL.
If space is insufficient, a separate sheet of paper may be attached.

Names and full address of employer, department, division or Position/Grade or rank where Date (Month and Year)
section* applicable
From To
Month Year Month Year
………………………………… …… …… …… ……
3. Name …………………………………………………… …………………………………
…… …… …… ……
…………………………………………………… …………………………………
…………………………………………………… ………………………………… …… …… …… ……
Address……………………………………………… ………………………………… …… …… …… ……
………………………………… …… …… …… ……
…………………………………
…… …… …… ……
4. Name…………………………………………………… …………………………………
……………………………………………………… ………………………………… …… …… …… ……
……………………………………………………… ………………………………… …… …… …… ……
Address…………………………………………….. ………………………………… …… …… …… ……
…………………………………
…… …… …… ……
…………………………………
5. Name …………………………………………………… ………………………………… …… …… …… ……
………………………………………………………. …………………………………
……………………………………………………… …………………………………
Address ……………………………………………. …………………………………
…………………………………
…………………………………
6. Name…………………………………………………… …………………………………
……………………………………………………… …………………………………
……………………………………………………….. …………………………………
Address……………………………………………….. …………………………………
…………………………………
…………………………………
7. Name………………………………………………… …………………………………
………………………………………………………… …………………………………
………………………………………………………… …………………………………
Address…………………………………………………

8. Name ……………………………………………………
…………………………………………………………
…………………………………………………………
Address………………………………………………

* Delete as necessary

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11. State briefly the qualifications and/or experience you possess which you consider best fit you for this post.

……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………

12. Do you suffer from any physical impairment? …………………. if so give details…………………………

……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………

13. Have you ever been convicted of any charge in a Court of Law?………………………………………………..

(a) Offence for which convicted

……………………………………………………………………………...

(b) Date and place of conviction

……………………………………………………………………………..

(c) Sentence imposed

………………………………………………………………………………………...

The fact of an applicant declaring that he has been convicted of an offence will not necessarily debar him from
employment in the Retirement Benefits Authority. Each case will be considered on its merits having regard to the
nature and the circumstances of the offence.

Have you ever with or without being convicted, been made the subject of a probation order? ………………………

14. Have you even been dismissed or otherwise removed from any previous employment? ……………………….

If so, give details …………………………………………………………………………………………………..

……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
………………………………………………………………………………………………………………….

15. I hereby certify that I do not suffer from any pecuniary embarrassment………………………………………...
(signature)

16. Personal Reference

Give the names and address of two referees. They 1. Name: Mr/Mrs/Miss ………………………………..
should be responsible persons who know you well,
either in private life or in business: and one at least Address: …………………………………………..
should be well acquainted with you in private life.
The names of distinguished persons should not be Occupation: ………………………………………..
given unless they really know you well; and the
names of relatives of those from who you send Period during which he/she has known you …………..

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 testimonials should not be given; nor shall the
names of Directors or staff of the Retirement 2. Name: Mr/Mrs/Miss ………………………………
Benefits Authority.
Address: ……………………………………………….

Occupation: …………………………………………..

Period during which he/she has known you……………

17. State the last post for which you were interviewed by the Authority, and date of interview:
POST: …………………………………………….
DATE: …………………………………………..

Date ……………………………………. …………………………………..

(signature of candidate)