FORM 1J

REPUBLIC OF KENYA

PARLIAMENTARY SERVICE COMMISSION

JOB APPLICATION FORM (FORM 1J)

(NOMINATION TO THE SALARIES AND REMUNERATION

COMMISSION)

Before completing this form, please read the following notes-

(a) Please make sure you have completed all sections of this document. It is an offence to willfully
give false information on this form. Do not apply for any position unless you possess all the
qualifications given in the advertisement.

(b) Please do not apply for any position unless you possess all the qualifications given in the job
advertisement.

(c) Do not enclose originals of your testimonials or certificates, instead send certified copies if
required. No responsibility can be accepted by the Parliamentary Service Commission for the
custody of original documents, unless a specific request has been made for their production.

(d) If you are invited to an interview, please bring the originals of your testimonials and certificates
with you, including your national Identity Card, but make sure that they are returned to you
before you leave the interview room.

(e) If the space provided in any of the sections is insufficient, please attach a separate sheet and
indicate accordingly.

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PRELIMINARY

POSITION ADVERTISED: ………………………………………………………………………

VACANCY NO.: ……………………………………………………………………………………

DATE ADVERTISED: ………………………………………………………………………………

SECTION I - BIO-DATA

1. Name of applicant: …………………………………………… Title: ……………………….

(e.g. Prof/Dr/Mr/Mrs/Miss/Ms/Rev)

2. Date of Birth: …….….………..………… Place of Birth …….….………..……………(County)

(dd-mm-yyyy)

3. Gender: Male ☐ Female ☐

4. Nationality…………………………….. ID/Passport No…………………………………………

5. Indicate the nature of your citizenship (birth/registration/naturalization) ……………………….

6. County……………………...Constituency……………………….Ward …………………………

7. Postal Address: …………….. Postal Code: ……………….. Town: ……………………………

8. Telephone: ………………………Mobile: …………………E-mail: …………………………….

9. Alternative contact person:………………………………..Telephone:………………………..

10. Indicate all languages you can read, write and speak proficiently.

………………………………………………………………………………………………………………………
11. What is your current employment/occupation (if any)?

Job Title/Position/Designation:…………………………………………………………………………………

Name and address of Employer: ………………………………………………………………………

………………………………………………………………………………………………………………………

12. What is your current gross monthly salary (if any)? ……………………………………………..

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13. Do you suffer from any impairment / disability?

No ☐ Yes ☐
If ‘Yes’, please give details and attach certificate from the National Council for Persons With
Disabilities
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14. If your application is successful, when would you be available to take up this position?

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SECTION II - ACADEMIC/PROFESSIONAL/TECHNICAL QUALIFICATIONS

15. List your Academic/Professional/Technical qualifications for Courses and Training attended
(starting with the highest)
(a) Qualification (Degree, Diploma or Certificate)

………………………………………………...……………………………………………………….
Level (Doctorate, Masters, Bachelors, etc.)

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Class (if any) (First Class, Upper Second, Lower Second, etc.)

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Year obtained.

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Awarding Institution/ College/University/School

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(b) Qualification (Degree, Diploma or Certificate)

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Level (Doctorate, Masters, Bachelors, etc.)

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Class (if any) (First Class, Upper Second, Lower Second, etc.)

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Year obtained.

……………………………………………………………….………………………………………..
Awarding Institution/ College/University/School

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(c) Qualification (Degree, Diploma or Certificate)

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Level (Doctorate, Masters, Bachelors, etc.)

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Class (if any) (First Class, Upper Second, Lower Second, etc.)

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Year obtained.

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Awarding Institution/ College/University/School

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16. List other courses you have attended in the last five (5) years.

Course attended Year attended Institution

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17. Briefly explain how your qualifications/experience make you suitable for this position?

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18. Are you a member of any professional body? If Yes, Indicate your membership status to
professional bodies. Provide Professional Registration/Membership details (Year Registered;
registering body) e.g. Full member Membership No. 20; 1993; Law Society of Kenya.

……………………………………………………………………………………………………….

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19. Give details of your employment history starting with current employment

Job title /Rank Employer Period Summary of Main duties/responsibilities

(start with current) (From – To)

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SECTION III - SPECIAL SKILLS/OUTSTANDING ACHIEVEMENTS

20. Do you possess any special or outstanding skills as described above? No ☐ Yes ☐

If yes, please give details/evidence. If the skills are in sports, please detail the level achieved. It is in
your interest to be as clear and specific as possible. If necessary, attach copies of any relevant
certificates.

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SECTION IV - INTEGRITY
The Parliamentary Service Commission is required by law to facilitate appointment of persons of
good character. The Commission is guided by the Constitution and other relevant laws in matters
relating to public officers’ character and integrity.
Please read the following guidelines carefully before completing this section.
(a) It is essential that you answer all the following questions fully.
(b) You are required to declare all matters whether or not these have been declared in a previous
application or to any other body.
(c) Where you have answered yes, please include any mitigating information you would like the
Commission to take into account when considering your application.
(d) If you are in any doubt, please include all relevant information. This is a continuing
responsibility throughout the process for any matter that may arise, up to the point of
appointment.

21. Have you ever been convicted of or cautioned for any criminal offence in Kenya or elsewhere or
are any criminal proceedings pending against you?

No ☐ Yes ☐

If yes, please give particulars of the case and the penalty (if any) for each such offence:

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(The fact that an applicant declares that he/she has been convicted of an offence will not necessarily
bar him/her from consideration for nomination. Each case will be considered on its own merits
having regard to the nature and the circumstances of the case).

22. Have you ever been dismissed or otherwise removed from any employment or any Board, Council,
Trusteeship or any other engagement? No ☐ Yes ☐

If yes, please provide details-

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23. Have you ever had an action brought against you for professional malpractice and/or negligence,
without the matter being dismissed, or are any such proceedings pending against you?

No ☐ Yes ☐

If yes, please provide details –

Date(s)
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Details

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24. In respect of any matter involving you personally or under your supervision, please provide
details of any findings made or allegations pending, of professional misconduct brought against
you by-

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(a) Your client/any member of the public

(b) Your Professional Body
(c) Any other lawful authority or body

If yes, please provide details –

Date(s)
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Details

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25. Is there any additional information which should be brought to the attention of Parliamentary
Service Commission which might call into question your eligibility or suitability for this
position?
No ☐ Yes ☐

If yes, please provide details-

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26. Give the names and addresses of three (3) referees. They should be responsible persons who
know you well, either in private life or in business: and one at least should be well acquainted
with you in private life. The names of distinguished persons should not be given unless they
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really know you well and they have consented. The names of relatives or of those from whom
you send testimonials should not be given; nor should the names of Members of Parliament,
members or staff of the Parliamentary Service Commission.

(a) Name………………………………………………………………………………………………

Address…..……………………………………………………………………………………………

Occupation……………………………………………………………………………………………

Period during which he/she has known you………………………………………………………….

In what capacity has the person known you?.......................................................................................

(b) Name……………………………………………………………………………………………….

Address…..……………………………………………………………………………………………

Occupation……………………………………………………………………………………………

Period during which he/she has known you………………………………………………………….

In what capacity has the person known you?........................................................................................

(c) Name………………………………………………………………………………………………

Address…..……………………………………………………………………………………………

Occupation……………………………………………………………………………………………

Period during which he/she has known you………………………………………………………….

In what capacity has the person known you?........................................................................................

27. Are you related in any way to any Member of Parliament, member or staffer of the
Parliamentary Service Commission? If so, please give details below:

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28. Final declaration

I declare that:
(i) The information I have given on this application form is true to the best of my knowledge and
belief;
(ii) I have read and understood the notes at the beginning of the application form and guidelines
under Section IV of the form;
(iii) I understand that any incorrect information may lead to disqualification/legal action; and
(iv) If I am completing this application form electronically, that the electronic signature I have
provided is intended to be my signature.

Full Names of applicant:……………………………………………………………………………….

Signature of applicant:………………………………. Date:………………………………………….

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