Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697808970535.pdf (Mauritius)
SMALL FARMERS WELFARE FUND 2nd Floor, MCIA (ex-FSC Building), St Pierre FOR OFFICIAL USE REF No : ……………..

APPLICATION FORM the Notes & Read carefully Instructions to candidates as mentioned in the advertisement before filling the form.

1.

Post Applied For: ……...………………………………………………………………………………..

Date of Advertisement/Vacancy Circular: ……………………………………………………………….

2.

National Identity No: Marital Status: Married Single Other: .............................
Title: Mr Mrs Miss Surname: (in block letters) Other Names: ……………………………………………………………………………………………………... (in block letters) Maiden Name (If applicable): …………………………………………………………………………………….. 3.

Residential Address: (in block letters) Phone Number: Office : ……………………… Home: …………………..

Mobile : ………….………… Date of Birth: ………………… Age: …………………….. Place of Birth: ……………………… Nationality: Certificate No (if Naturalised): Date: 5.
SECONDARY ORDINARY LEVEL (Attach photocopies) State whether Cambridge S.C or Cambridge G.C.E London General Certificate of Education (‘O’ level) Examining Body: Month/Year: Exam Centre No: Index No: Examining Body: ………………………………….

Month/ Year: ….……………………………….

Exam Centre No: Index No: ………………………………….

Subject Grade Subject Grade Result ………………………… Aggregate ……………… Result ………………………… Aggregate ……………… Page 1 of 5 6.
SECONDARY ADVANCED LEVEL(Attach photocopies) State whether H.S.C or Cambridge G.C.E London General Certificate of Education (‘A’ level) Examining Body: Month/Year Exam centre No: Index No: Examining Body: ………………………………….

Month/ Year: …………………………………..

Exam Centre No: Index No: ..………………………………….

Principal Grade Principal Grade Subsidiary Subsidiary Result ………………………… Result ………………………… 7.
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 ................................. 8.

TECHNICAL AND VOCATIONAL QUALIFICATIONS (e.g.

Typing & shorthand, B.A.P, I.V.T.B Certificate (NTC) etc.)
(Attach photocopies) Examining Body: ……………………………….............. Institution Attended: ………………………………………………… Duration of course/study: From …………….

To ………….

Part Time Full Time Distance Education Specify: (i) Exact qualifications obtained ……………………………………………….. Class/Division/Level ……………… (ii) Date of Result: …………………… Subject(s): (State whether main/subsidiary/major etc where applicable) Page 2 of 5 9.
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: …………………………………………………………… Subject(s): (State whether main/subsidiary/major etc where applicable) 10.
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: …………………………………………………………… Subject(s): (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: …………………………………………………………… Subject(s): (State whether main/subsidiary/major etc where applicable) 11.

Other Qualifications as laid down in the advertisement: 12.
Experience and skills relevant to the post applied for (Attach documentary evidence) Page 3 of 5 13.

EMPLOYMENT HISTORY (a) Present Employment Post Held Temporary/Substantive Min./Department Date of Appointment Date of Confirmation Present Salary per Month (Rs) (b) Previous Employment Post Held Date From To Min./Department (c) EMPLOYMENT OTHER THAN IN THE GOVERNMENT/PARASTATAL SERVICE Post Held Date From To Name and address of employer 14.
If on leave without pay whilst in government service/Parastatal body during the last five years state: Period on leave: From........................................ To....................................... Purpose (study, employment etc.....) Give details if applicable: (Organisation Post held etc.)

15.

(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 judgement and sentence – e.g.

imprisonment, fine, caution or conditional discharge): - 16.

Have you ever resigned or retired or been dismissed from the Public Service on any grounds whatsoever?

Answer Yes or No ………….


If Yes, give details: - Page 4 of 5 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/her appointment.
DECLARATION I, the particulars in this application form are true and accurate and that I have not wilfully suppressed any material fact.

the undersigned applicant, declare that Date: Signature: Page 5 of 5