Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697808990215.pdf (Mauritius)
SPECIAL EDUCATION NEEDS AUTHORITY Application Form Post Applied for Title (Tick as appropriate) Dr ⁯ Mr ⁯ Mrs ⁯ Ms ⁯ Miss ⁯ Surname (in block letters) Other Names (in block letters) Maiden Name (if applicable) National Identity No.

Marital Status Married…..

Single ….. (Tick as appropriate) Other: ……………………………...

Residential Address Phone No Office Home Mobile Email address Date of birth: Age: Nationality: Certificate No.
if naturalized: Date: 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: SPECIAL EDUCATION NEEDS AUTHORITY Application Form State whether Cambridge H. S. C. or Cambridge G.C.E.
or London General Certificate of Education (A Level) ……………………………………………………………... ……………………………………………………………... Month/Year Exam Centre No.

Index No.

Month/Year Exam Centre No.

Index No.

Subject Level Grade Subject Level Grade Level-Principal (P), Subsidiary(S), Advanced Subsidiary(AS) Level- Principal (P), Subsidiary(S), Advanced Subsidiary(AS) 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: Certificate: Year: Subject Grade Marks Percentage SPECIAL EDUCATION NEEDS AUTHORITY Application Form TECHNICAL AND VOCATIONAL QUALIFICATIONS (e.g.

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

Certificate (NTC) etc.)


(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:….……………………………..………………………... (ii) Class/Division/Level:………………………………………….………………………….

(iii) Date of Result:…………………………………………………………………………….
Subjects (State whether main/subsidiary/major etc where applicable) 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:…………………………………………………………... (ii) Class/Division/Level:……………………………………………………………………... (iii) Date of Result:…………………………………………………………………………….
Subjects (State whether main/subsidiary/major etc where applicable) SPECIAL EDUCATION NEEDS AUTHORITY Application Form 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:…………………………………………………………... (ii) Class/Division/Level:…………………………………………………………………...... (iii) Date of Result:…………………………………………………………………….……… Subjects (State whether main/subsidiary/major etc where applicable) POST DEGREE (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:………………………………………………………….... (ii) Class/Division/Level:……………………………………………………………….……... (iii) Date of Result:……………………………………………………………………………..
Subjects (State whether main/subsidiary/major etc where applicable) Other Qualifications as laid down in the advertisement (e.g.

Driving License (Specify type), First Aid, IT, etc.)
SPECIAL EDUCATION NEEDS AUTHORITY Application Form Experience and skills relevant to the post applied for (Attach documentary evidence) PRESENT EMPLOYMENT in the Government Service (if applicable) Post held Temporary/Substantive Ministry/Department Date of Appointment Date of Confirmation Present basic salary per month (Rs) PREVIOUS EMPLOYMENT in the Government Service (if applicable) Post/s held Temporary/Substantive Min./Dept From/To EMPLOYMENT other than in the Government service (if applicable) Post/s held Name and Address of employer From To 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.

SPECIAL EDUCATION NEEDS AUTHORITY Application Form 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).
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 or, if a candidate has already been appointed, to the termination of his appointment.
I, ………………………………………………………………………..the undersigned applicant, declare that the particulars in this application are true and accurate and that I have not willfully suppressed any DECLARATION material fact.

Date:……………………………………………….. Signature:………………………………………….

For Official Use Only Remarks: …………………………………………………………………….…………………… ………………………………………………………………………………………… Date: ……………………………....