PSBE 1: (REVISED 2019)

REPUBLIC OF KENYA

EMBU COUNTY GOVERNMENT

EMBU PUBLIC SERVICE BOARD

APPLICATION FOR EMPLOYMENT FORM

Please complete this form in BLOCK letters as appropriate and submit to the Secretary, Public Service Board of
Embu P.O. BOX 2871, 60100 EMBU, Tel 0722547089.

1. Vacancy Applied For:

Position:……………….……………………...................................Vacancy No. ........................................................................

Department/Directorate:………………..……………….......................................................................................................... .....

2.Personal Details of the Applicant:

Name of applicant: ……………………………….…. …………..….................................... Title:………

Surname) First Name other Name(s): (Prof/Dr/Mr/Mrs/Miss/Miss/Rev)

Date of Birth:………………… IDNo.……………..........PNO………..…...................... Gender Male Female

(dd-mm-yyyy) O O
Nationality:………………………………Ethnicity:………………………Home County:………………………..................
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Sub County:………………………..Constituency ………………….............Ward:.……….……..…….…............................
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Address:……………………………………………PostalCode:………………...........Town…..…………………………… e e
Telephone:……………………………………Mobile:………………………………E-mail address:…………’…………......
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: :
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Name of Alternative contact person:.……………….................Telephone:................................. Relationship………………...
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3.Applicants in the Public Service only: 2 2
2 2
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Ministry/Department/County/Other Public Institutions:……………....……………………………..Station:………...................
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Personal/Employment No......................................Present Substantive Post:……………………………………........................
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Job group:……………………................... Date of Current Appointment:….....................................................................
(dd-mm-yyyy)
Upgrading Post (if applicable):…………………………………… effective date of previuos appointment:…………………
(dd-mm-yyyy)

Terms of Service: Permanent & Pensionable Contract Temporary/CasualO/ther

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Gross Monthly Salary..................................................... Expected Gross Monthly Salary.........................................................
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4. Other details: T
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Indicate the language(s) you are proficient in…………………………………………………………………………………
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Do you suffer from any physical impairment? Yes
: : No :
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If yes (i) give details/Nature of Disability……………………………………………………………………...…….……….
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(ii) Details of Registration with National Council5for People with Disabilities 5 (Reg. No. and Date).............................................
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Have you ever been convicted of any criminal offences 7 eor a subject of probation
7 order? Yes e No 7 O
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Our Address: Trade Building 2nd Floor, 8 Kaunda Street P.O.
8 Box 2871-60100 Embu ,Tel:
u 0722547089 8 u
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 Have you ever been dismissed or otherwise removed from employment? Yes No
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If Yes, State reason (s) for dismissal/removal…………………..………………………………effective u u
date………………

Have you ever been interviewed by Public Service Board of Embu before? Yes
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If Yes, State the Post:………………………………… Interview date:………………………….…………………………... eu ue
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(Declaring the above information will not necessarily debar an applicant from employment in Public Service of Embu.
Each case will be considered on its own merit) :T T:
66.emic /Professional/Technical Qualifications (Starting with the Highes 0e e0
5. Academic/Professional/Technical Qualifications (starting with the Highest) 7l 7
l2
2
University/College/ Award/Attainment Courses
2:
Subject
:2 Class/Grade
5 5
Institution/School (e.g Degree, (e.g PhD,40Msc, (Econ,Maths04e.t.c)
7 7
Year Diploma, BA) 7 2 27
Certificate) 02 20
85 58
From To 94 49
7 7
0 0
8 8
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6. Other Relevant Courses and Training attended Lasting not less than One (1) week

Year Institution/College Courses Details

From To

7. Current Registration/Membership to Professional Bodies

Professional Body Membership/Registration Membership type (e.g. Date of Renewal

No. Associate, Full etc)

Our Address: Trade Building 2nd Floor, Kaunda Street P.O. Box 2871-60100 Embu ,Tel: 0722547089
 8. Employment Details (starting with the most recent)

Year Employer’s Name Position/Rank/Designation Job Group/Gross Monthly

Salary (Kshs.)
From To
mm/yyyy mm/yyyy

9. Briefly state your current duties, responsibilities and assignments …………………………………………………………..

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10. Please give details of your abilities, skills and experience which you consider are relevant to your current position . The
information may include an outline of your most recent achievements and your reasons for retaining the same position.
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Our Address:Trade Building 2nd Floor, Kaunda Street P.O. Box 2871-60100 Embu ,Tel: 0722547089
11. Personal References
The names of distinguished persons should not be used unless they really know you well; the names of relatives or of those
from whom you send testimonials should not be used. The names of members or staff of the Public Service Board of Embu
should also not be used.

1. Full Name (Current Supervisor)……………………………………………………………………………..........................

Address:…………………………………………………………………………………………..………………………….......
Telephone No/Mobile No.…………………………………… E-mail address:………………………......................................
Occupation:…………………………………………………………………………………...…………………………………
Period for which he/she has known you:………………………………………..………………………………………….........
2. Full Name……………………………………………………………………………….……………….…………………...
Address:………………………………………………………………………………….………………..……………………...
Telephone /Mobilie No.……………………………………………. E-mail address:…………………………………………...
Occupation:………………………………………………………………………………………………..……………………..
Period for which /he/she has known you:…………………………………………………………e....
12. Assistance to fill the form

Have you been assisted to fill this form? Yes No

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If yes give reasons..........................................................................................................
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13. Declaration T T
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I hereby certify to the best of my knowledge that the particulars given on this lform are correct and I understand that l any
incorrect information may lead to disciplinary. action.
: :
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Date: ……………………………. … …………………………..
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(dd-mm-yyyy) Signature
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2 2
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Our Address:Trade Building 2nd Floor, Kaunda Street P.O. Box 2871-60100 Embu ,Tel: 0722547089