COLLEGE OF BUSINESS EDUCATION DAR ES SALAAM/DODOMA/MWANZA

No:-----APPLICATION FORM FOR DIPLOMA COURSES ORDINARY DIPLOMA IN BUSINESS ADMINISTRATION/ACCOUNTANCY/PROCUREMENT&SUPPLIES/MARKETING/ INFORMATION AND COMMUNICATION TECHNOLOGY

TFC/TNC 2012 - DBA/DA/DPS/DMK/DICT

(Underline the course and Session of your choice) The Principal College of Business Education P.O. Box 1968 Dar es Salaam. NOTE: a)

AFFIX PHOTO PASSPORT SIZE

Applicant must affix a photograph on the space provided. Application form without a photograph will not be considered. This form when completed must reach the Principal by 31st May,2012 Each applicant must pay Tsh 25,000 for the application fee.

b) c)

PART I STUDENTS DETAILS: 1. 2. SURNAME: (Block Letters)..

First Names in Full (Block Letters) NOTE: The names entered in this form must be the same as those on your official Academic certificates. 3. 4. 5. Date of Birth . Place of Birth Nationality ..By Birth By Registration No.DatePlace 6. 7. 8. Present Address .Tel./Mobile.. Permanent Home Address Forwarding address as from 31st May, 2012 if different from 6 above. . 1

9. 10. 11. 12. 13. 14. 15.

Religion .. Marital status Number of Children.. Present Employer.. Employed as.. Salary scale .. Have you ever been convicted of a Criminal Offense? YES/NO If yes give details..

16. 17.

Disability/Special needs. State of health..

PART II EDUCATIONAL QUALIFICATION 18. School(s) and College(s) attended School or Colleges Attended Types: Primary/Secondary Certificate obtained and Dates

(Use a separate sheet if space is insufficient)

19. Professional/sub-professional Qualifications Body NABE, NBAA, NBMM etc. Stage completed Certificates obtained and Dates

Notes: It is important that copies of the following documents (NOT ORIGINAL) attached: (a) (b) (a)

are

National Form Four Examinations Certificate School Leaving Certificate Any other relevant certificates supporting qualifications stated under No.17 and 18 above including the birth certificate. PREVIOUS EMPLOYMENT RECORDS

PART III 20.

Particulars of your employment since leaving School or College including periods of training, apprenticeship, self-employment or unemployment. Name and Full Address of Employer From (Month and Year) To (Month and Year) Position(s) Held

PART IV

FINANCIAL STATUS

21. Course fees will be paid by a) b) My employer (Name).. Any other sponsoring organization or person (Name)

Note: If you have ticked (a) or (b) please ask your prospective sponsor to Complete No. 21. 22. EMPLOYERS/SPONSORS CERTIFICATE

(To be completed by a responsible officer authorized by the Organization/Family) (a) We.. approve sponsorship of the above applicant and hereby confirm that he/she will be released (from employment etc) for the purpose of attending the course for the whole of the required period. We further confirm that our Corporation/Company/Family/Organization/ Ministry will sponsor the applicant if accepted, and pay the College fees as indicated on the attached sheet, and as may be amended, from time to time. We also undertake to confirm that the applicant is physically fit and that he/she has no criminal records to the best of our knowledge. Signed Name Rank. On behalf of . Any other comments.. I CERTIFY THAT THE INFORMATION GIVEN ABOVE IS CORRECT.

(b)

SIGNATURE OF THE STUDENT

DATE