Application Form

Particulars of Candidate.

Application Number: NNR33/2022/KAT/1806/0028840

National Identification Number: 52514247100

Bank Verification Number: 22443847132

Department: Education

Exam Centre: Kastina

Center Location: 35 BN KATSINA

Title: MR Surname: SALISU

First Name: SANI Other Name: Nill

Religion: Islam Marital Status: Single

Gender: Male Date Of Birth: 6/18/1998

State of Origin: KATSINA LGA of Origin: Mashi

Home Town: Mashi LG Mobile Number: 09033873128

Height(Meters): 1.70 No. of Children: 0

Hobbies: Nil Email: sanisalis134@gmail.com

Permanent Address GRA mashi

Contact Address GRA mashi

 Application Form

Next of Kin's Information

Full Name: AUWAL SALISU Relationship: SENIOR BROTHER

Occupation: TELORING Mobile Number: 07034648654

Email: auwalsalisumashi@gmail.com Post: Chef

Contact Address: GRA mashi

Parent's / Guardian's Information

Full Name: SALISU HUSSAINI

Residential Address: GRA mashi

Referees

Referee Name Referee Address Referee Phone

Rakiya SALISU 08145394367

Salisu Hussain GRA MASHI 08036767343

Education Information

Primary Details

School Qualification From To

Mashi Primary certificate 2004 2010

Secondary Details

School Qualification From To

Government commacial college ma'adua Secondary certificate 2010 2016

Tertiary Details

Institution Course of Study Type From To Classification

Fce katsina Business education NCE 2016 2019 Pass

 Application Form

SSCE / NECO / WASSCE / GCE

No. of sittings: Exam Number 1:

Subject Grade Examination

English C6 CREDIT 21005092

Financial Accounting A1 EXCELLENT 21005092

Mathematics C4 CREDIT 21005092

Economics C4 CREDIT 21005092

Commerce C4 CREDIT 21005092

 Application Form

Have you taken Covid19 Vaccine? Yes

Have you ever served in the Armed Forces or any other security agency?No
Give details (if Yes):
 
 
Reason for leaving:
 
 
Have you suffered any mental illness before? No
Give details (if Yes):
 
Do you have any disability? No
Give details (if Yes):
 
 
Have you ever been convicted by a Court of Law? No
State reason (if Yes):
 
Conviction:
 
 
Do you have any relative(s) serving or that served in the Armed Forces?

Full Name: Force:

Last Rank: Still in service?:

Full Name: Force:

Last Rank: Still in service?:

 Application Form
APPLICANT'S DECLARATION

Application Number: NNR33/2022/KAT/1806/0028840

I SALISU SANI, hereby declare that the information given in this application is true and that if found to be
false I should be prosecuted.

Signature: _______________________________ Date: _______________________________

 Application Form
Consent by Parent/Guardian

Application Number: NNR33/2022/KAT/1806/0028840

I _____________________________________ parent/guardian of ______________________________________, who is

applying for recruitment into the Nigerian Navy, hereby certify that I fully understand that my child/ward will
(if required to) attend the Recruitment Exercise and I shall not demand compensation or relief from the
Government in respect of death or any injury which my child/ward may sustain in the course of or as a
result of any task given to him/her during the exercise.

Parent / Guardian Witness

Name: _________________________________ Name: _________________________________

Address: _______________________________ Address: _______________________________

Signature: _______________________________ Signature: _______________________________

Date:_______________________________ Date:_______________________________
 Application Form
LOCAL GOVERNMENT AREA CERTIFICATION

Application Number: NNR33/2022/KAT/1806/0028840

Title: MR Surname: SALISU

First Name SANI Other Name Nill

Religion Islam Marital Status Single

Date Of Birth: Thursday, June 18, 1998 Gender Male

State of Origin: KATSINA LGA of Origin: Mashi

Home Town Mashi LG Mobile Number 09033873128

Height(Meters) 1.70 Email: sanisalis134@gmail.com

Permanent Address GRA mashi

Certification by LGA Chairman / Secretary Or Senior Military Officer not below the rank of
Commander or equivalent Or Chief Superintendent Of Police from Applicant's State of Origin

I certify that the applicant ___________________________________ is an indigene of _______________________

L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form
are correct. I hereby declare that if any statement made in connection with this application is proven to be
false I should be prosecuted.

Name:_________________________________________

Address:_________________________________________________________________

Signature:_________________________________________

Date:_________________________________________
 Application Form
POLICE CERTIFICATION

Application Number: NNR33/2022/KAT/1806/0028840

Title: MR Surname: SALISU

First Name SANI Other Name Nill

Religion Islam Marital Status Single

Date Of Birth: Thursday, June 18, 1998 Gender Male

State of Origin: KATSINA LGA of Origin: Mashi

Home Town Mashi LG Mobile Number 09033873128

Height(Meters) 1.70 Email: sanisalis134@gmail.com

Permanent Address GRA mashi

Certification by Divisional Police Officer

I certify that the applicant _________________________________ is an indigene of ______________________Town,

_________________________ L.G.A, ________________ State and that his/her parent hails from
__________________________ L.G.A. of _________________ State. That he/she has no criminal record on him/her.
(If any state briefly
_________________________________________________________________________________________________________________
That to the best of my knowledge and belief the facts stated in the form are correct and I hereby declare that
if any statement made in connection with this application is proven to be false I should be prosecuted.

Name:_______________________________

Address:_______________________________

Signature:_______________________________

Date:_______________________________
 GUARANTOR'S FORM

Application Number: NNR33/2022/KAT/1806/0028840

Title: MR Surname: SALISU

First Name SANI Other Name Nill

Religion Islam Marital Status Single

Date Of Birth: Thursday, June 18, 1998 Gender Male

State of Origin: KATSINA LGA of Origin: Mashi

Home Town Mashi LG Mobile Number 09033873128

Height(Meters) 1.70 Email: sanisalis134@gmail.com

Permanent Address GRA mashi

Particulars of Guarantor

Surname: ______________________________________ First Name: ____________________________________

Middle Name: _________________________________ Town: _________________________________________
LGA: __________________________________________ State of Origin: ________________________________
Mobile: ________________________________________ E-mail: ________________________________________
Appointment: __________________________________ How long have you known the candidate:_______
Formation/Unit/Office Address: _________________________________________________________________
Residential Address: ___________________________________________________________________________
Contact Address: ______________________________________________________________________________
Name: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________
This form is to be filled by a Military Officer not below the rank of Lt Col or equivalent/Police Officer not
below the rank of Chief Superintendent of Police/Assistant Director at either Federal or State Civil Service
certifying the eligibility of the applicant. You need not to come from an applicant’s State of Origin to
guarantee him/her only be sure of the character. Please note that inability to confirm the above given
information about you, will lead to automatic disqualification of the candidate.
 Application Form
FOR OFFICIAL USE ONLY

Application Number: NNR33/2022/KAT/1806/0028840

Applicant's Full Name: SALISU SANI
Date Received:_____________________________________
Education Qualification: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical fitness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
 
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director, DRRR
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________