TRAINING APPLICATION FORM

SIRARI CORRIDOR ACCESSIBILITY & ROAD SAFETY IMPROVEMENT PROJECT

TRAINING OF YOUTH AND WOMEN CONTRACTORS

OBJECTIVE OF THE TRAINING

The training component entails support to the youth and women Contractors
recently/currently working in any of the Counties traversed by the Project Road or in the
Neighboring Counties: i.e. Migori, Kisii, Homabay, Nyamira, Kisumu and/or neighbouring
counties i.e. Siaya, Kericho, Bomet, Narok, Busia and Bungoma.. In order to enhance skills
of Contractors in the region and for purposes of maintenance of the completed Roads, the
program shall select a minimum of two (2) personnel for each successful
Applicant/Contractor to be trained in several areas in the wider Construction industry and
specifically in Road Construction.

ELIGIBILITY

➢ Must be registered/Incorporated in any of the Counties traversed by the Project Road

or in the Neighboring Counties: i.e. Migori, Kisii, Homabay, Nyamira, Kisumu and/or
neighbouring counties i.e. Siaya, Kericho, Bomet, Narok, Busia and Bungoma. Their
company/ business addresses should be from any of the counties.

➢ OR
Must be currently working or have recently worked (within the last 5 years) in any of
the counties mentioned above. Any Contractor who has shown interest in working in
any of the counties shall also be considered.
➢ Nominated Contractor’s personnel must be Kenyan citizen or Kenyan permanent
resident.

ii. Preference will be given to:

a. Contractors registered under Youth, Women and Persons with Disability Programme of the
GoK, ie with AGPO Certificate.
b. Women and hence they are encouraged to apply.

APPLICANTS SHOULD PROVIDE:

➢ Copy of Certificate of Incorporation;
➢ Copy of Certificate of Registration with National Construction Authority (NCA)
➢ Completed application form;
➢ AGPO Certificate, if Applicable
➢ Copies of National ID cards of Directors and Nominees
 PART A: CONTRACTOR’S DETAILS

Contractor Name
Note: Attach Certificate of Incorporation/Registration of the Company

Email

Telephone No
NCA Registration Class

Note: Attach NCA Registration Certificate

Box Number Postal Code Town

Current Place of Business

Note: Attach Business Permit if Applicable

County Constituency Sub County

Give details of all directors as follows:

Name in full Nationality Gender Citizenship Details* Shares (%)

*Note: Attach proof of citizenship/National Identity Card

Give details of Projects Undertaken in the Region (within the last 3 years)*

Project Description and Employer/Client Value (KShs) Duration County

Scope

• Note: Attach Evidence of Projects undertaken eg. Award Letter, completion

Certificate, Reference letter from Client

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These forms can be downloaded from the KeNHA website (https://kenha.co.ke/application-forms/)

PART B : CONTRACTOR’S NOMINEES DETAILS
Contractor’s Nomminee 1

Nominee Name

Position/Role in the Company

Gender

Category(Youth/Women/PWD)*

Nominee Tel Number

Nominee Email Adress

Contractor’s Nomminee 2

Nominee Name

Position/Role in the Company

Gender

Category(Youth/Women/PWD)*

Nominee Tel Number

Nominee Email Adress

Contractor’s Nominee 3

Nominee Name

Position/Role in the Company

Gender

Category(Youth/Women/PWD)*

Nominee Tel Number

Nominee Email Adress

*Notes –Attach copy of Identification Card of Nominee

-Attach evidence if Nominee is PWD

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These forms can be downloaded from the KeNHA website (https://kenha.co.ke/application-forms/)

TERMS AND CONDITIONS
1. In cases where a nominee is unavailable at the time of training, the selected Contractor
may propose another nominee for consideration by KeNHA.

2. Any applicant who gives false information or submits fake documents in support of the
request for training shall be liable to disqualification and prosecution.

Note :

• All spaces in this form should be filled, otherwise the application will not be
considered.

• All forms to be received on or before 3rd August, 2023

• Only shortlisted applicants will be contacted.

ATTACHMENTS

i) Certificate of Incorporation/Registration Yes No

ii) NCA Registration Certificate Yes No

iii) AGPO Certificate Yes No

iv) Business Permit Yes No

v) Evidence of Projects Undertaken Yes No

vi) Citizenship Details of Directors Yes No

vii) Copy of National ID/Passport for Nominees Yes No

viii)PWD Evidence for Nominee Yes No

ix) Preferred Training Location

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These forms can be downloaded from the KeNHA website (https://kenha.co.ke/application-forms/)

APPLICANT CERTIFICATION

I hereby certify that all the information I have provided on this form and all supplementary
forms is true, correct, and complete. Any falsified information may lead to disqualification.

Applicant signature: _____________________Date: ______________________________

Official Stamp:

Note: The filling of this application form does not guarantee that the applicant will receive sponsorship.

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These forms can be downloaded from the KeNHA website (https://kenha.co.ke/application-forms/)