Officer Use

Application Approved: YES/NO

Chairman’s Signature: __________________

DEPARTMENT OF EDUCATION
Date of Notification: __________________
To: The Chairman (EI, PI, SI):
Provincial Standards Committee: _____________________________________________________________
_____________________________________________________________

Sub: APPLICATION FOR PERSONAL INSPECTION (Close on 30th April)

I wish to apply for Personal Report under Section 46 and 47 of the Teaching Service Act No.12 0f 1988, in conjunction with Section 28 of
the National Education Act No.163 of 1983. This application is for: (tick appropriate box)

A. A Declaration of Eligibility B. An Extension of Tenure C. Both Declaration of Eligibility and Extension of Tenure

A. Personal Information (use official name on payroll)

First Surname
Name Gender File No.#

School Sector Province

Design No. of Years on
ation Level (EO) this position
Date Employment
Tenure Acting / Substantive Appointed Type Nat; OSC; VSO; MV; Other

B. Experience
Year Began Number of Year Full Registration
Teaching Years Teaching Registered No.#
Tenure Tenure
Sub Level Tenure School Province Year
Year of last Purpose of last Reg, Pers, TSC, Compul, Result of Satis, Elig, If eligibility,
Transfer, Force, Other US
Inspection Inspection? Rating? Level?

C. Qualifications
G10 Cert
G10 School G10 Year No.#
G12/Matric G12/Matric G12/Matric
School Year Cert No#
Teaching Year
Qualification Completed Institution

Signature: ______________________________________________ Date: ____________________________

cut………………………………………………………………………………………………………………………………………….cut
D. Notification slip
Name & Postal Address ……………………………………………………………………………………………………………..
An assessment of your work will be carried out this year as requested. You will be notified of the date and other details.
You will not receive an assessment of your work this year because……………………………………………………………….
……………………………………………………………………………………………………….. You may reapply next year.
You will not receive an assessment of your work this year because of large number of applicant and because other officers have
priority. However, your performance of duty is considered satisfactory, and if this continues a letter will be written
recommending an extension of tenure.
You will not receive a personal report this year because you will be given a compulsory inspection under Secretary’s Instruction
No. 3 of 2006

Chairman:____________________________________________ Date:_________________________

NOTE: It is a requirement for the inspecting officer(s) to check and verify all your original certificates and relevant documents
during the process of inspection. Any false information declared on this application will not only result in disqualifying your
application and report but can attract forced inspection for trying to mislead the inspection system.