Application Form

Application Number: Department: HYDROGRAPHY Specialisation

DSSC27/2019/OGU/385/0007493 Cartography

Title: MR Surname: JAIYESIMI First Name: IBUKUN

Other Name: EMMANUEL Religion: christianity Marital Status: Single

Gender: Male Date Of Birth: 3/3/1990 State of Origin: OGUN

LGA of Origin: Ijebu-North Home Town: Ijebu-igbo Mobile Number: 08139332354

Height(Meters): 1.72 No. of Children: 0 Hobbies: Arts and

entertainment

Email: Permanent Address 8, college road idomila. Ijebu-

jaiyesimibukun@gmail.com ode

Contact Address Nnamdi azikwe international airport Abuja

Next of Kin's Information

Full Name: MR. BABAJIDE Relationship: BROTHER Occupation: SELF EMPLOYED

JAIYESIMI

Mobile Number: 08070989552 Post: Email:

Contact Address: Ijebu-ode

Parent's / Guardian's Information

Full Name: MR. TAIWO JAIYESIMI Residential Address: 8, college road idomila.
Ijebu-ode
 Application Form

Referees

Referee Name Referee Address Referee

Phone

Mr Ime Udo Ibong EKIM ITAM-ITU L.G.A . AKWA-IBOM 08023256578

Mr. ADELEYE ADETAYO 30, ENVIRONMENTAL STREET FHA PHASE 2 LUGBE 08020673991
ADEBANJO ABUJA

Primary Details

School Quali cation From To

Gloria nry/pry school, Ijebu-ode FSLC 1996 2001

Secondary Details

School Quali cation From To

Pobuna senior secondary school, poka . Epe SSCE 2002 2008

Tertiary Details

Institution Course of Type From To Classi cation

Study

OBAFEMI AWOLOWO UNIVERSITY, ILE- B.Sc Degree 2008 2012 Second Class
IFE GEOGRAPHY Lower
 Application Form

SSCE / NECO / WASSCE / GCE

Nysc Number: A002688130 Exam Number: 500994901

Subject Grade

Mathematics C5 CREDIT

Geography C4 CREDIT

Biology C5 CREDIT

Physics C4 CREDIT

Chemistry C4 CREDIT

Economics C5 CREDIT

English C5 CREDIT
 Application Form
APPLICANT'S DECLARATION

Application Number: DSSC27/2019/OGU/385/0007493

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

Signature: _______________________________ Date: _______________________________

Certi cation by Parents / 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

Application Number: DSSC27/2019/OGU/385/0007493

Title: MR Surname: JAIYESIMI

First Name IBUKUN Other Name EMMANUEL

Religion christianity Marital Status Single

Date Of Birth: Saturday, March 3, 1990 Gender Male

State of Origin: OGUN LGA of Origin: Ijebu-North

Home Town Ijebu-igbo Mobile Number 08139332354

Height(Meters) 1.72 Email: jaiyesimibukun@gmail.com

Permanent Address 8, college road idomila. Ijebu-ode

Certi cation by LGA Chairman / Secretary Or Senior Military O cer 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: DSSC27/2019/OGU/385/0007493

Title: MR Surname: JAIYESIMI

First Name IBUKUN Other Name EMMANUEL

Religion christianity Marital Status Single

Date Of Birth: Saturday, March 3, 1990 Gender Male

State of Origin: OGUN LGA of Origin: Ijebu-North

Home Town Ijebu-igbo Mobile Number 08139332354

Height(Meters) 1.72 Email: jaiyesimibukun@gmail.com

Permanent Address 8, college road idomila. Ijebu-ode

Certi cation by Divisional Police O cer

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 brie y
________________________________________________________________________________________________________________________
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: DSSC27/2019/OGU/385/0007493

Title: MR Surname: JAIYESIMI

First Name IBUKUN Other Name EMMANUEL

Religion christianity Marital Status Single

Date Of Birth: Saturday, March 3, 1990 Gender Male

State of Origin: OGUN LGA of Origin: Ijebu-North

Home Town Ijebu-igbo Mobile Number 08139332354

Height(Meters) 1.72 Email: jaiyesimibukun@gmail.com

Permanent Address 8, college road idomila. Ijebu-ode

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/O ce Address: _________________________________________________________________
Residential Address: ___________________________________________________________________________
Contact Address: ______________________________________________________________________________
Name: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________
This form is to be lled by a Military O cer not below the rank of Lt Col or equivalent/Police O cer 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 con rm the above given
information about you, will lead to automatic disquali cation of the candidate.
 Application Form
FOR OFFICIAL USE ONLY

Application Number: DSSC27/2019/OGU/385/0007493

Applicant's Full Name: JAIYESIMI IBUKUN
Date Received:_____________________________________
Education Quali cation: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical tness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________