KAS/FM/HCA/045

APPLICATION FOR INTERNSHIP/ATTACHMENT FORM

Please complete this form in BLOCK LETTERS and submit it online to

internships@kasneb.or.ke
1. Full name: _______________________________________________________________

2. Nationality: _______________________________________________________________

3. Date of Birth: ___________________________ ID/Passport No._____________________

Day Month Year

4. Gender: ____________________________ PIN No. ______________________________

5. County of Birth: ______________________ County of Residence____________________

6. Disability Status (if any):_____________________________________________________

7. Mobile Number: _______________________ e-mail_______________________________

8. Postal Address: ___________Postal Code:____________ Town/City: ________________

9. (a) Qualifications:
Academic/Professional Qualifications Year of Completion

Note: Attach copies of relevant academic/professional certificates.

(b) Computer Literacy:

__________________________________________________________________

__________________________________________________________________

10. Area of interest:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

I ________________________________certify that the above information is true to the best of my

knowledge.

Signature: ________________________ Date : ________________________________________

Rev.0/2018