Sammy Navy - Form

Application Form
Particulars of Candidate.
Application Number: NNR35/2023/KOG/1835/0039529
National Identification Number: 57607652970
Bank Verification Number: 22460437176
Department: Weapon Electrical Mechanics
Exam Centre: Kwara
Center Location: NNSHS OFFA
Title: MR Surname: ADEYEMI
First Name: SAMUEL Other Name: Oluwajuwonlo
Religion: christianity Marital Status: Single
Gender: Male Date Of Birth: 7/7/1998
State of Origin: KOGI LGA of Origin: Mopa – Muro
Home Town: Ilorin Mobile Number: 07037054179
Height(Meters): 1.65 No. of Children: 0
Hobbies: Football, Gyming Email:

halleluyahsamuel@gmail.com
Permanent Address Be-Bethel Academy Gbaganu minna Niger State
Contact Address Be-Bethel Academy Gbaganu minna Niger State

Application Form
Next of Kin's Information
Full Name: YEMISI GIFT ADEYEMI Relationship: SISTER
Occupation: BUSINESS WOMAN Mobile Number: 09020169689
Email: Halleluyahsamuel@gmail.com Post:
Contact Address: Behind Day Secondary Amoyo, Ilorin Kwara State
Parent's / Guardian's Information
Full Name: PASTOR VICTOR OWOTUNSEMINNA
Residential Address: Bact of St Mary's Church Gbaganu Minna Niger State
Referees
Referee Name Referee Address Referee

Phone
Mr Victor BACK OF ST MARY'S CHURCH GBAGANU MINNA NIGER 08063220148

Owotunse STATE
Mr Victor BACK OF ST MARY'S CHURCH GBAGANU MINNA NIGER 08063220148

Owotunse STATE
Education Information
Primary Details
School Qualification From To
LIMAWA MODEL PRIMARY SCHOOL PLSC 2008 2013

Secondary Details
School Qualification From To
Umar Faruk Bahago Secondary School SSCE 2014 2017
Tertiary Details
Institution Course of Study Type From To Classification
THE FEDERAL POLYTECHNIC OF BIDA Chemical Engineering OND 2019 2020 Pass
Application Form
SSCE / NECO / WASSCE / GCE
No. of sittings: Exam Number 1:
Subject Grade Examination
English C6 CREDIT 4271637009
Chemistry C5 CREDIT 4271637009
Physics C6 CREDIT 4271637009
Mathematics B3 GOOD 4271637009
Civic Education A1 EXCELLENT 4271637009

Application Form
Have you taken Covid19 Vaccine? No

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

Do you have any disability? No

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
I ADEYEMI SAMUEL, 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
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
First Name SAMUEL Other Name Oluwajuwonlo
Religion christianity Marital Status Single
Date Of Birth: Tuesday, July 7, 1998 Gender Male
Home Town Ilorin Mobile Number 07037054179
Height(Meters) 1.65 Email:

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

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

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

Applicant's Full Name: ADEYEMI SAMUEL
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:_____________________________________________________

Sammy Navy - Form

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Application Form

Application Number: NNR35/2023/KOG/1835/0039529

National Identification Number: 57607652970

Bank Verification Number: 22460437176

Department: Weapon Electrical Mechanics

Exam Centre: Kwara

Center Location: NNSHS OFFA

Title: MR Surname: ADEYEMI

First Name: SAMUEL Other Name: Oluwajuwonlo

Religion: christianity Marital Status: Single

Gender: Male Date Of Birth: 7/7/1998

State of Origin: KOGI LGA of Origin: Mopa – Muro

Home Town: Ilorin Mobile Number: 07037054179

Height(Meters): 1.65 No. of Children: 0

Hobbies: Football, Gyming Email:

Permanent Address Be-Bethel Academy Gbaganu minna Niger State

Contact Address Be-Bethel Academy Gbaganu minna Niger State

Next of Kin's Information

Full Name: YEMISI GIFT ADEYEMI Relationship: SISTER

Occupation: BUSINESS WOMAN Mobile Number: 09020169689

Email: Halleluyahsamuel@gmail.com Post:

Contact Address: Behind Day Secondary Amoyo, Ilorin Kwara State

Parent's / Guardian's Information

Full Name: PASTOR VICTOR OWOTUNSEMINNA

Residential Address: Bact of St Mary's Church Gbaganu Minna Niger State

Referee Name Referee Address Referee

Mr Victor BACK OF ST MARY&#39;S CHURCH GBAGANU MINNA NIGER 08063220148

Mr Victor BACK OF ST MARY&#39;S CHURCH GBAGANU MINNA NIGER 08063220148

School Qualification From To

LIMAWA MODEL PRIMARY SCHOOL PLSC 2008 2013

School Qualification From To

Umar Faruk Bahago Secondary School SSCE 2014 2017

Institution Course of Study Type From To Classification

SSCE / NECO / WASSCE / GCE

No. of sittings: Exam Number 1:

Subject Grade Examination

English C6 CREDIT 4271637009

Chemistry C5 CREDIT 4271637009

Physics C6 CREDIT 4271637009

Mathematics B3 GOOD 4271637009

Civic Education A1 EXCELLENT 4271637009

Have you taken Covid19 Vaccine? No

Reason for leaving:

Have you suffered any mental illness before? No

Do you have any disability? No

Have you ever been convicted by a Court of Law? No

Full Name: Force:

Last Rank: Still in service?:

Full Name: Force:

Last Rank: Still in service?:

Application Number: NNR35/2023/KOG/1835/0039529

Signature: _______________________________ Date: _______________________________

Application Number: NNR35/2023/KOG/1835/0039529

I _____________________________________ parent/guardian of ______________________________________,

Parent / Guardian Witness

Name: _________________________________ Name: _________________________________

Address: _______________________________ Address: _______________________________

Signature: _______________________________ Signature: _______________________________

Application Number: NNR35/2023/KOG/1835/0039529

Title: MR Surname: ADEYEMI

First Name SAMUEL Other Name Oluwajuwonlo

Religion christianity Marital Status Single

Date Of Birth: Tuesday, July 7, 1998 Gender Male

Mr Victor BACK OF ST MARY'S CHURCH GBAGANU MINNA NIGER 08063220148

Mr Victor BACK OF ST MARY'S CHURCH GBAGANU MINNA NIGER 08063220148

Signature: _ Date: _

I _ parent/guardian of __,

Name: _ Name: _

Address: _ Address: _

Signature: _ Signature: _

I certify that the applicant _____________ is an indigene of _

I certify that the applicant ___________ is an indigene of Town,

Surname: __ First Name: