Other Training, Professional Qualifications, Membership of Professional Bodies

Job Application Form
Please complete clearly in type or black ink and return to: Leanne Kennedy, InterHealth, Masanduku Lane, Nairobi 19595-00202 marked “Private & Confidential" or e-mail to

Post applied for: / Date of application:
Salary expected: / Closing date:
Where did you see this post advertised?

Personal Details

Surname: / Forenames:
Title:
Address:
Post Code:
Telephone no. / Day / Evening
E-mail address:

Qualifications/Training

Schools Attended / From / To / Qualification/results (with grades)
Colleges/Universities Attended / From / To / Qualification/results (with grades)

Other training, Professional Qualifications, Membership of Professional Bodies:

Employment History (most recent first)

Current or most recent employer first and in full detail. Please include temporary posts and work experience

Employer’s name & address / From / To / Job title and duties / Final salary & reason for leaving

General Comments in Support of Your Application

Please detail here your specific reasons for this application, your main achievements to date, and the strengths you would bring to this post and any other information relevant to your application. Continue on no more than one separate sheet if necessary.

Leisure

Please note here your leisure interests including positions of responsibility held.

Christian Faith

Please briefly describe your faith journey and how that faith impacts on your work day-to-day.

References (one should be your current or most recent employer)

Please give the details of two referees and state how they know you. References will normally only be taken up for the successful candidate and will be considered by the selection panel after the interviews have taken place.

Referee 1

/ Referee 2
Name
Job Title
Address
Post Code
Telephone no.
E-mail

Disclosure of Criminal Records

Have you been convicted of a criminal offence? YES/NO If YES, please give details

Declaration – please read this carefully before signing this application

I confirm that the above information is complete and correct and that any untrue or misleading information will give InterHealth the right to reject my application, to withdraw my employment contract offered or, if employed, to dismiss without notice.

The information you provide on this form will only be used in accordance with the principles of the Data Protection Act 1998. If you are appointed it will form the basis of your personal record.