Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697809530379.pdf (Mauritius)
MINISTRY OF AGRO-INDUSTRY AND FOOD SECURITY Application for the post of Project Coordinator PART A 1.

Title: Mr Mrs Miss (Tick as appropriate) Surname: …………………………………………………………………………………………………... (in block letters) Other Names: ..…………………………………………………………………………………………….... (in block letters) Maiden Name (if applicable): ……..……………………………...………………………………………… National Identity Card No.

: ………………………………………………………………………………….. 2.

Date of Birth: ……………………………… Place of Birth: ……………….……………………...
Nationality: …………………………… Certificate No.

(If naturalised) ……………..

Date: ……………….. 3.

Full Residential Address: …………………………………………………………………………………………… (in block letters) 4.

Phone No.

Office: …………………….

Home: ……………………… Mobile: …………..………………….. 5 (a) 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.
Centre No.

Index No.

………………………………………………………………… ………………….

Month/Year Exam.

Centre No.

Index No.
Subject Grade Subject Grade ..................................................................................................... ...................................................................................................... ..................................................................................................... ...................................................................................................... ..................................................................................................... ...................................................................................................... ..................................................................................................... ...................................................................................................... ..................................................................................................... ...................................................................................................... ..................................................................................................... ...................................................................................................... ..................................................................................................... ...................................................................................................... ………………………………………………………………….
.….................................................................................................

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

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

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

Aggregate..................... 5 (b) SECONDARY ADVANCED LEVEL 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.


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

Exam.

Centre No.

Month/Year Index No.
Subject Level Grade Subject Level Grade ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... Level — Principal, Subsidiary, Advanced Subsidiary Level — Principal, Subsidiary, Advanced Subsidiary Result...................................
 5 (c) 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....................... 5 (d) 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) ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... 5 (e) 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) ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... ................................................................................................. ...................................................................................................... 6.
Other Qualifications as laid down in the advertisement(e.g.

Driving Licence (Specify type), First Aid,IT etc.

Specify date) 7.

Experience and skills relevant to the post applied for(Attach documentary evidence) 8.

EMPLOYMENT HISTORY 8.1 (i) Present Employment in the Government Service Post held Temporary/Substantive Min./Dept.
......................................................... .............................................................. ..............................................................

Date of Present Appointment Date of Confirmation in the Service Present Salary per month Rs .............................................................. (Date Month Year e.g.

01 01 02 (ii) Previous Employment in the Government Service Post held Temporary/Substantive Min./Dept.
Date of Appointment .................................................. .................................................. ................................................. ................................................. .................................................. .................................................. ................................................. ................................................. .................................................. .................................................. .................................................. ................................................ 8.2 If on leave without pay whilst in government service during the last five years state : Period on leave : From.............................. To.............................. Purpose (study, employment etc...) Give details if applicable: (Organisation, Post held etc.)
8.3 EMPLOYMENT OTHER THAN IN THE GOVERNMENT SERVICE Post/s Date From To Name and address of employer .................................................. .................................................. ................................................. ................................................. .................................................. .................................................. .................................................. ................................................. .................................................. .................................................. ................................................... …............................................. 9.
(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) :— ........................................................................................................................................................................................................... ............................................................................................................................................................................................................ 10.
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 :— ............................................................................................................................................................................................... ............ ........................................................................................................................................................................................................... ........................................................................................................................................................................................................... ........................................................................................................................................................................................................... 11.
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 wilfully suppressed any material fact.

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