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REVISED FORM 1 - 01/12/2008

TELEPHONE:

3611100

FAX:

3907426

REVISED FORM 1 - 01/12/2008 TELEPHONE: 3611100 FAX: 3907426 MINISTRY OF LABOUR AND HOME AFFAIRS PRIVATE

MINISTRY OF LABOUR AND HOME AFFAIRS PRIVATE BAG 002 GABORONE BOTSWANA

APPLICATION FORM DEPARTMENT OF NATIONAL INTERNSHIP PROGRAMME

  • 1. PERSONAL DETAILS MR/MS/MRS/DR: LAST NAME: …………………………………………………….FIRST NAME…………………………………………………… DATE OF BIRTH:

DAY………………………………

..

MONTH………………………………………….…………… YEAR……………………

..

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NATIONAL REGISTRATION NUMBER …………………………………………………………………………………………………………………….

GENDER (Please tick where appropriate)

MALE

  • FEMALE

GENDER ( Please tick where appropriate ) MALE FEMALE

_______________________________________________________

MARITAL STATUS (Please tick where appropriate)

SINGLE

  • MARRIED

( Please tick where appropriate ) SINGLE MARRIED

DIVORCED

  • WIDOWED

DIVORCED WIDOWED

CORRESPONDENCE ADDRESS (Where the correspondence should be sent) ……………………………………………………………

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

REVISED FORM 1 - 01/12/2008 TELEPHONE: 3611100 FAX: 3907426 MINISTRY OF LABOUR AND HOME AFFAIRS PRIVATE

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

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

  • 2. COMMUNICATION TELEPHONE NUMBER ……………………………………………………………

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FAX

NUMBER ………………………………………………………

MOBILE NUMBER …………………………………………………………………… E-MAIL ……………………………………………………………….

  • 3. NEXT OF KIN DETAILS OF NEXT OF KIN: PARENT/GURDIAN/SPOUSE: ………………………………………………………………………………………… SURNAME:………………………………………………FIRST NAME: ……………………………………………………………………………………… CORRESPONDENCE ADDRESS (Where they could be contacted) ……………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………… TELEPHONE/MOBILE ……………………………………………………………………………………………………………………………………………

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  • 4. EDUCATIONAL ACHIEVEMENTS: DEGREE PROGRAMME …………………………………………………………………………………………………………………………………………… POST GRADUATE PROGRAMME ……………………………………………………………………………………………………………………………….
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FROM

 

TO

DATE

MONTH

YEAR

MONTH

YEAR

FULL TIME/PART-TIME

           
           
           

NAME OF EXAMINATION

 

PERIOD

CORE/ MAJOR COURSES

MONTH

YEAR

REVISED FORM 1 - 01/12/2008 4. EDUCATIONAL ACHIEVEMENTS: DEGREE PROGRAMME …………………………………………………………………………………………………………………………………………… POST GRADUATE PROGRAMME ………………………………………………………………………………………………………………………………. --------------------------------------------------------------------------

NAME OF INSTITUTION ………………………………………………………………………………………………………………………………………….

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

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  • 5. INTEREST FIELD OF INTEREST ………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………… IS IT DIFFERENT FROM WHAT YOU STUDIED? …………………………………………………………………………………………………… REASONS……………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… PREFERRED ENTITY/ORGANISATION (CENTRAL GOVERNMENT, LOCAL GOVERNMENT, PRIVATE SECTOR, NON- GOVERNMENTAL ORGANISATION, ETC)……………………………………………………………………………………………………………………. REASONS……………………………………………………………………………………………………………………………………………………………… .. ……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… __________________________________________________________________________________________________

  • 6. PREFERRED LOCATION (PLACE) OF SERVICE (WHERE OWN ACCOMMODATION IS AVAILABLE) …………………………………………………………………………………………………………………………………………………………………………… ..

  • 7. KEY COMPETENCIES ………………………………………………………………………………………………………………………………………… .. ………………………………………………………………………………………………………………………………………… .. ………………………………………………………………………………………………………………………………………… .. ………………………………………………………………………………………………………………………………………… ..

  • 8. REFEREES

A) …………………………………………………

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…………………………………………………

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……………………………………………………

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C)

…………………………………………………….

…………………………………………………….

……………………………………………………

B) ………………………………………………………………………………….

……………………………………………………………………………………

…………………………………………………………………………………

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REVISED FORM 1 - 01/12/2008

9.

REQUIREMENTS

i)

CERTIFIED COPIES OF CERTIFICATES

ii)

CERTIFIED COPIES OF TRANSCRIPTS WHERE NECESSARY

iii)

CERTIFIED COPIES OF NATIONAL REGISTRATION (OMANG)

iv)

C.V./ RESUME

  • 10. AFFIRMATION/ DECLARATION BY APPLICANT I do declare or affirm that the information contained is true and correct to the best of my knowledge and belief.

I

am aware that the Department reserves the right to reject my

application or terminate enrollment should the information contained above be found to be

incorrect or not true. I am also aware that the Department reserves the right to place me where

it deems necessary, and subject to availability of places.

NAME OF APPLICANT …………… ………… ……………………………………………………………………………

.. ..

..

SIGNATURE ………………………………………………………….DATE…………………………………………………….

FOR OFFICIAL USE ONLY

FIELD OF ALLOCATION ……………………………………………………………………………………………………………………………………………………… ..

ORGANISATION/COMPANY…………………………………………………………………………………………………………………………………………………… ..

PREFERRED LOCATION OF SERVICE (PLACE)……………………………………………………………………………………………………………………………

AREA/PLACE OF ALLOCATION ……………………………………………………………………………………………………………………………………………… ..

COMMENCEMENT DATE …………………………………………………………………………………………………………………………………………………………

NAME OF RECIPIENT: …………………………………………………………………………….SIGNATURE OF RECIPIENT………………………………………

DATE ……………………………………………………………………………………………………………………………………………………………………………………

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