Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697809266588.pdf (Mauritius)
MINISTRY OF LOCAL GOVERNMENT AND DISASTER RISK MANAGEMENT Application Form 1.

Post Applied for ..................................................................................................................................

Date of Advertisement................................................................................................................................. 2.

National Identity No.


Title Mr Mrs Miss Marital Status : Married Single Surname :............................................................................................................................ ....................... (in block letters) Other Names :.................................................................................................................................................. (in block letters) Maiden Name (if applicable)……………………………………………………………………………………….
Residential Address …………………………………………………………………………………………………… 3.

(in block letters) …………………………………………………………………………………………………………….

Phone No : Home................................

Mobile........................ Office............................ Email address :.......................................

Date of Birth Age Place of Birth.......................................................................................................

Nationality.......................................

Certificate No.
Certificate No.

(If Naturalised).................................................& Date..................................... 4.

SECONDARY ORDINARY LEVEL State whether Cambridge S. C. or Cambridge G.C.E.

or London General Certificate of Education (Ordinary Level) ................................................................................................. ...................................................................................................... Month/Year Exam.

Centre No.

Index No.


Month/Year Exam.

Centre No.

Index No.
Subject Grade Subject Grade ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ........... ................................................................................... ...........
Result...........................

Aggregate.....................

Result...........................

Aggregate..................... 1 5.

SECONDARY ADVANCED LEVEL State whether Cambridge H. S. C. or Cambridge G.C.E.

or London General Certificate of Education (A Level) ............................................................................................... Month/Year Index No.

Exam.

Centre No.
Exam.

Centre No.

...................................................................................................... Month/Year Exam.

Centre No.

Index No.
Subject Level Grade Subject Level Grade ............................................................................. .............. ............ ............................................................................. .............. ............ ............................................................................ .............. ............ ............................................................................ .............. ............ ............................................................................. .............. ............ ............................................................................. .............. ............ ............................................................................ .............. ............ ............................................................................ .............. ............ ............................................................................ .............. ............ ............................................................................ .............. ............ ............................................................................ .............. ............ ............................................................................ .............. ............ Level — Principal, Subsidiary, Advanced Subsidiary Level — Principal, Subsidiary, Advanced Subsidiary Result...................................
 6.

Other Secondary Qualifications (e.g.

Baccalaureat, Matriculation, Secondary & Higher Secondary Certificates from Overseas).
Note : Attach photocopies of marksheets/result slips and equivalence of certificates (if available) Examining Body............................................................................................................................... Country.......................................................................................................................Year................
Certificate.......................................................................................................................................... Subject Grade Marks Percentage ........................................................................................... ............ .......................................................................................... ............ ........................................................................................... ............ .......................................................................................... ............ .......................................................................................... ............ .......................................................................................... ............ ........................................................................................... ............ .......................................................................................... ............ ........................................................................................... ............ .......................................................................................... ............ .......................................................................................... ............
Result...................................... ................... ..................... ................... ..................... ................... ..................... ................... ..................... ................... ..................... .................. ..................... ................... ..................... ................... ..................... ................... ..................... ................... ..................... ................... ..................... TOTAL....................... 7.
TECHNICAL AND VOCATIONAL QUALIFICATIONS (e.g.

Typing and shorthand, B.A.P., Technician Certificate, I.V.T.B.

Certificate (NTC) etc.)

Name of University/Examining Body.............................................................................................. Country........................................
Duration of course/study : From.........................To..................... Part Time Full Time Distance Education Specify (i) exact qualifications obtained................................................................................. Class/Division/Level.......................... (ii) Date of result :.........................................................
Subjects (State whether main/subsidiary/major etc where applicable) ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... 2 8.
DIPLOMA QUALIFICATIONS (Below Degree level) (Attach photocopies of marksheets) Name of University/Examining Body.............................................................................................. Country........................................
Duration of course/study : From.........................To..................... Part Time Full Time Distance Education Specify (i) exact qualifications obtained................................................................................. Class/Division/Level.......................... (ii) Date of result :.........................................................
Subjects (State whether main/subsidiary/major etc where applicable) ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... 9.
DEGREE/PROFESSIONAL QUALIFICATIONS (Attach photocopies of marksheets) Name of University/Examining Body.............................................................................................. Country........................................
Duration of course/study : From.........................To..................... Part Time Full Time Distance Education Specify (i) exact qualifications obtained................................................................................. Class/Division/Level.......................... (ii) Date of result :.........................................................
Subjects (State whether main/subsidiary/major etc where applicable) ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... 10.
POST DEGREE QUALIFICATIONS (Attach photocopies of marksheets) Name of University/Examining Body.............................................................................................. Country........................................
Duration of course/study : From.........................To..................... Part Time Full Time Distance Education Specify (i) exact qualifications obtained................................................................................. Class/Division/Level.......................... (ii) Date of result :.........................................................
Subjects (State whether main/subsidiary/major etc where applicable) ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... 11.
Other Relevant Qualification as laid down in the advertisement(Attach photocopy, if any) 12.

Experience and Skills relevant to the post applied for (Attach documentary evidence) Date Post(s) Name and Address of Employer From To 3 13.

Present Employment Present Employment & Post Held Date of Present Appointment Date confirmed (if in permanent post) Present Basic Salary (Rs) Salary Scale 14.

(a) Have you been the subject of an investigation/enquiry for any offence during the last 10 years ?
Answer Yes or No.

...................

If Yes, indicate nature of offence and date of outcome.
........................................................................................................................................................................................................... ........................................................................................................................................................................................................... (b) Have you ever been prosecuted before a court of law for any offence AND subsequently found guilty during the last 10 years ?
Answer Yes or No.

..................

If yes, give details (court, charge, date of judgment and sentence - e.g.
imprisonment, fine, caution or conditional discharge) :— ........................................................................................................................................................................................................... ............................................................................................................................................................................................................ 15.
IMPORTANT – PLEASE READ THE ADVERTISEMENT CAREFULLY : Incomplete, inadequate or inaccurate filling of the form may cause the applicant's elimination from consideration.

It is an offence to give false information or to conceal any relevant information.

This may lead to an application being rejected.

I,.
I,.

............................................................................ , the undersigned applicant, declare that the particulars in this application are true and accurate and that I have not willfully suppressed any material fact.

DECLARATION Date ......................................... Signature...............................................................

INSTRUCTIONS 1.
INSTRUCTIONS 1.

Please complete the application form, fully in original, in your own handwriting and forward it to the Senior Chief Executive , Ministry of Local Government and Disaster Risk Management, 3rd Floor, Emmanuel Anquetil Building, c/r SSR & Jules Koenig Streets, Port Louis.

2.

Please read the advertisement carefully, and do not apply if you do not have the full professional and/or academic qualifications laid down in the advertisement.

3.
3.

Please attach relevant photocopies of birth and educational certificates.

4.

It is an offence to give false information or to conceal any information on this form.

4