APPLICATION FORM

1.

POST APPLIED FOR

DATE OF ADVERTISEMENT

2.

SURNAME (in block letters)

TITLE
(Mr. Mrs. Miss)

FOR OFFICIAL
USE ONLY
REF NO.

MARITAL
STATUS

OTHER NAMES (in block letters)

MAIDEN NAME (If Applicable)

3.

FULL RESIDENTIAL ADDRESS (in block letters)

TELEPHONE No. (If Any)

Acknowledge
on .. Receipt

Home: ..
Office:
Mobile:..
4.

DATE OF BIRTH
..

5.

SECONDARY INSTITUTIONS ATTENDED:

6.

DETAILED RESULTS OF CAMBRIDGE

SCHOOL CERTIFICATE
YEAR
.

AGE

NATIONAL IDENTITY NO:

. NATIONALITY: ..

EXAMINATION CENTRE
..

INDEX
NO.:

DETAILED RESULTS OF GENERAL

CERTIFICATE OF EDUCATION (O LEVEL)
(CAMBRIDGE OR LONDON)
YEAR
EXAMINATION CENTRE
.
.

INDEX
No:

JAN OR JUNE:.
SUBJECT

GRADE

SUBJECT

GRADE

..

..

..

..

..

..

..

..

..

..

..

..

SC RESULT: ..

AGGREGATE:

TH

6 Floor, The Celicourt, Sir Celicourt Antelme Street, Port-Louis

Tel: (230) 206-3000 Fax: (230) 211-7007 Email: wma@intnet.mu URL: wma.gov.mu

7. DETAILED RESULTS OF HIGHER SCHOOL

CERTIFICATE

YEAR
.

EXAMINATION CENTRE
NO..

DETAILED RESULTS OF GENERAL

CERTIFICATE OF EDUCATION (A LEVEL)
(CAMBRIDGE OF LONDON)
INDEX
NO.

SUBJECT PASSED
PRINCIPAL
GRADE
SUBSIDIARY
LEVEL
LEVEL
. ..

YEAR
.

EXAMINATION CENTRE
NO:.

INDEX
NO

..
GRADE

ADVANCED
LEVEL
.. ..

"O" LEVEL

GRADE

..

..

.. ..

..

..

.. ..

..

..

.. ..

GENERAL PAPER:..
8.

HSC RESULT:..

OTHER QUALIFICATIONS (ACADEMIC/PROFESSIONAL OR TECHNICAL)

Qualification and Date Obtained

Class/
Division

Examination
institution

Duration of Study
From
To

Subject/s taken

(Please attach statement if necessary)

9.

SPECIAL/POSTGRADUATE QUALIFICATIONS AND EXPERIENCE AS LAID IN THE ADVERTISEMENT.

(State here to what extent you hold such qualification/experience)

(Please attach statement if necessary)

TH

6 Floor, The Celicourt, Sir Celicourt Antelme Street, Port-Louis

Tel: (230) 206-3000 Fax: (230) 211-7007 Email: wma@intnet.mu URL: wma.gov.mu

10.
(A)

EMPLOYMENT HISTORY
POST PRESENTLY HELD

ORGANISATION
ADDRESS/TEL NO.

DATE OF PRESENT
EMPLOYMENT/APPOINTMENT

PRESENT SALARY
Rs:
SALARY SCALE

(B)
1

POST PREVIOUSLY HELD

ORGANISATION

NATURE OF WORK

FROM

(Please attach statement if necessary)

11.

Have you ever been convicted of any criminal offence?

Yes/No

12.

Have you ever resigned or been dismissed or discharged from the service of any employer?

Yes/No

If the answer to item(s) 11 and/or 12 is yes, please give details hereunder or in an attached statement if necessary.
.
..
NB. PLEASE READ THE ADVERTISEMENT CAREFULLY: Incomplete, inadequate or inaccurate filling of the form
may cause your elimination from consideration. It is an offence to give false information or to conceal any
information on this form.
Please attach photocopies of birth certificate, examination certificate and any other papers. ORIGINALS TO BE
PRODUCED WHEN REQUESTED.
The post/s applied for should be clearly written on the left hand side of the enveloppe.
I declare that the particulars in this application form and in the sheets attached thereto are true to the best of my
knowledge and belief and that I have not willfully suppressed any material fact.
Date:

TH

Signature of Applicant

6 Floor, The Celicourt, Sir Celicourt Antelme Street, Port-Louis

Tel: (230) 206-3000 Fax: (230) 211-7007 Email: wma@intnet.mu URL: wma.gov.mu

TO