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REVISED FORM 1 - 01/12/2008

TELEPHONE: 3611100 MINISTRY OF LABOUR AND HOME AFFAIRS


FAX: 3907426 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……………………..

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

GENDER (Please tick where appropriate) MALE FEMALE


_______________________________________________________
MARITAL STATUS (Please tick where appropriate) SINGLE MARRIED

DIVORCED WIDOWED

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

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

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

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

2. COMMUNICATION

TELEPHONE NUMBER ……………………………………………………………..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

PERIOD
NAME OF EXAMINATION CORE/ MAJOR COURSES
MONTH YEAR

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) ………………………………………………….. B) ………………………………………………………………………………….

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

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

C) …………………………………………………….

…………………………………………………….

……………………………………………………

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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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