REPUBLIC OF MAURITIUS

L.G.S.C. Form 7

FOR OFFICIAL USE

Read carefully the enclosed notes
& Instructions to candidates
before filling this form
LOCAL GOVERNMENT SERVICE COMMISSION
Application Form
1. Post Applied for...... INDEX NO
Municipality/District Council ......
Date of Advertisement/Vacancy Circular .................. .
Previous Posts Applied for 1 .......

2 ......

2. SURNAME Male Female

(in block letters)

Other Name(s)
Mr/Mrs/Miss

(in block letters) - (Photocopy of Birth Certificate to be enclosed)

Maiden Name (if applicable)

DATE OF BIRTH MARITAL STATUS National ID No. (Photocopy of NIC to be enclosed)

Date Month Year Married Single

Nationality Certificate No. (If Naturalised)...& Date .

3. RESIDENTIAL ADDRESS (in block letters)

Telephone No. Home: ...

Office: ..

Mobile: .

Email ......

QUALIFICATIONS TICK AS APPROPRIATE PHOTOCOPY TO BE ENCLOSED

4. PRIMARY LEVEL CPE
5. SECONDARY ORDINARY LEVEL SC GCE LONDON GCE O LEVEL

6. SECONDARY ADVANCED LEVEL HSC GCE A Level LONDON GCE A LEVEL

7. OTHER SECONDARY QUALIFICATIONS SPECIFY_____________________________________________________

8. TECHNICAL AND VOCATIONAL QUALIFICATIONS SPECIFY _________________________________________

9. DIPLOMA QUALIFICATIONS SPECIFY____________________________________________________________

10. DEGREE/PROFESSIONAL QUALIFICATIONS SPECIFY __________________________________________________

11. POST DEGREE QUALIFICATIONS SPECIFY ___________________________________________________________

12. OTHER QUALIFCATIONS AS LAID DOWN IN THE ADVERTISEMENT SPECIFY ____________________________

13. EXPERIENCE AND SKILLS RELEVANT TO THE POST APPLIED FOR (ATTACH DOCUMENTARY EVIDENCE)
EMPLOYMENT HISTORY

14.1 In the LOCAL GOVERNMENT SERVICE

(i) Present Employment
Post held Temporary/Substantive Local Authority

.............................................................. .............................................................. .................................................

Date of Present Appointment Date of Confirmation in the Service Present Salary per month
Rs
Date Month Year Date Month Year

(ii) Previous Employment

Post held Temporary/Substantive Local Authority Date of Appointment
............................................ ............................................ ............................................ ............................................
............................................ ............................................ ............................................ ............................................
............................................ ............................................ ............................................ ............................................
(iii) Have you ever resigned or been dismissed or retired from the Local Government Service on any grounds whatsoever?

Yes No
If yes, give details:-

..

14.2 OTHER THAN LOCAL GOVERNMENT SERVICE (INCLUDING PARASTATALS)

Post/s Date Name and address of employer

From To
........................................................... .................................. ................................... ...........................................................
........................................................... .................................. ................................... ...........................................................

15. Have you ever been prosecuted before a court of law for any offence AND subsequently found guilty?

Yes No

If yes, give details (court, charge, date, sentence e.g. prison, fine, caution or conditional discharge):-...

..

16. IMPORTANT - PLEASE READ THE ADVERTISEMENT CAREFULLY: Incomplete, inadequate or inaccurate
filling of the form may cause the applicants elimination from consideration. It is an offence to give
false information or to conceal any relevant information. This may lead to an application being
rejected or, if a candidate has already been appointed, to the termination of his appointment.

DECLARATION

I am aware that a public notification regarding the appointment/promotion of successful candidate/s (when applicable) will be posted on
the website of the Local Government Service Commission.

I,........................................................................................., the undersigned applicant, declare that the particulars in this application are true
and accurate and that I have not willfully suppressed any material fact and that I have read and understood the notes and instructions to
candidates as well as that in the advertisement.

Date.......................................... Signature.....................................................................