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IEBC APPLICATION FORM

INDEPENDENT ELECTORAL AND BOUNDARIES COMMISSION APPLICATION FOR EMPLOYMENT FORM

Complete this form in BLOCK letters as appropriate and submit to The Commission Secretary/ Chief Executive Officer, Independent Electoral and Boundaries Commission, 6th Floor Anniversary Towers, University Way, Nairobi and/or filled electronically on the Commission website (www.iebc.or.ke/careers)

I Vacancy Applied For

CONSTITUENCY ELECTIONS COORD. Vacancy/Post: …………………………………………………………Vacancy No: …………………………… II Personal Details

MR RAWLINGS JUMAH ANGIRAH Name of applicant: ……………………………….…………………………… Title: ………………………. (e.g. Prof/Dr/Mr/Mrs/Miss/Ms/Rev)

02-06-1975 Date of Birth: …….….………..………………… Gender:

Male

Y

Female

(dd-mm-yyyy)

13891777………………………….. KENYAN Nationality: ……………………………………….. ID/Passport No ……………….. KOMBEWA 7 KOMBEWA 40102 Address: BOX ………………………….. Postal code: …………………….. Town: ………………………………… KISUMU KISUMU RURAL County……………………………………………… Home District : ……………………………..…………… KANYADWERA KISUMU RURAL Constituency ………………….................................. Division …………………………………………………. LUO Ethnic Community …………………............................. Sub Division …………………………………………. 0721284068 Telephone: …………………………

0721284068 rawlings2270@yahoo.com Mobile: ……………………… E-mail: ………………… ……………..

0711507015 Alternative contact person: ……………………………………… Telephone: ………………………………… SOPHIE AWINO

III Other Details Do you suffer from any impairment / disability?

Yes

No

x

If ‘Yes’, give details:

Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


2 IV

Academic/Professional/Technical Qualifications as per the advertisement

List your Academic/Professional/Technical qualifications Academic/Professional/Technical Qualifications (Starting with the highest)

Grade/ Class/ GPA

Post Graduate Diploma in Education

67

BSc. (Mathematics/Chem) Hons.

2nd Cls.

Year obtained

2004 2001

Institution/ College/University/School attended

Egerton University University of Nairobi

KCSE

B

1995

Mbugra Mixed

KCPE

69/84

1990

Masogo Primary

Certificate in Comp. Applications

Cert

2002

Electrocom Computers, Ksm

V Other courses and training attended List other courses you have attended in the last five (5) years. Course attended

Year attended Institution

Methodology, Preparation, on KCSE

March 2012

Roles of Presiding Officer

Aug 2010

ICT Integration in Learning

2008 to date

PDE-Nyanza/Skidnet Workshop IIEC CEMASTEA

Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


3 VI Registration/Membership to Professional bodies Indicate your membership status to professional bodies. Registration/Membership details

Year Registered Registering body

e.g Full member No. 20

1993

TSC No. 466655

2004

Engineers Registration Board

Teachers Service Commission

VII Employment details Give details of your employment history starting with current employment Job title /Rank (start with current)

Senior Master Deputy Principal (BOG Appt.) Exams Master

Organisation/ Company

Period (From –To)

Waware Sec 2011 to date Waware Sec. 2010-2011 Waware Sec 2008-2010

Manager/Principal Highway Sec 2006-2007 Academic Master Bolo Girls Teacher

VIII

Bolo Girls

2004-2006 2002-2004

Summary of Main duties /responsibilities

-Coordinate remedial programmes -Coordinate all exams -Incharge of Discipline -Incharge of curriculumn Implementation -Coordinate all Exams -Manage School on behalf of Arab Reform Association, Kisumu -Incharge of all Academic program -Teaching, Class teacher and incharge of a co-curricular activity

CHARACTER

The IEBC is required by statute to facilitate appointment of persons of good character. The IEBC is therefore guided by the Constitution and other relevant laws in relation to Public Officers character

and integrity. Please read the following guidelines carefully before completing this section. It is essential that you answer all the following questions fully. You are required to declare all matters whether or not these have been declared in a previous application or to any other body. Please include comparable information for all jurisdictions relevant to you and your work. Where you have answered yes, please include any mitigating information you would like the IEBC to take into account when considering your application. 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.

Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


1.

Have you ever been convicted of or cautioned for any criminal offence or hae any other proceedings pending against you No (NO)

Yes

If yes, please give details of the case and any penalty for each offence:

(The fact of an applicant declaring that he/she has been convicted of an offence will not necessarily debar him/her from employment in IEBC. Each case will be considered on its own merit having regard to the nature and the circumstances of the offence).

2.

Have you ever been dismissed or otherwise removed from employment or any Board, Council, Trustee or any other engagement? No (NO)

Yes

If Yes give details

3.

(i)

Have you at any time:

a)

Been involved in a matter that would amount to a conflict of interest? No (No)

b)

Yes

Made a composition with your creditors? No (No)

Yes

Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


c)

Been adjudged bankrupt? No (No)

d)

Yes

Been sued to judgement for any debt? No (No)

Yes

If yes, please provide details including any issues relating to the adherence of any agreement made or details about any such proceedings pending.

Date (s)

Details

ii. What is your loan exposure with financial institutions? Please give details

I have a Mwalimu Sacco Loan of less than Kshs 90,000/=.

4. In relation to VAT or any other form of tax or rates, have you ever had proceedings brought against you, or are any proceedings pending regarding:

a) Outstanding, or late submissions; personal returns? No (No) Yes If yes explain detail


Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


b) Outstanding debts of personal tax or duties?

No (No)

Yes

c) Any on-going enquiries being made into your personal returns of tax or duties? No (No)

Yes

If yes, please provide details including whether you have paid a penalty or made a composition in respect of failure to pay tax or duties or incurred any other default. Date(s)

5.

Details

Are you up to date on payment of your loan with the Higher Education Loans Board (where applicable)? No

Yes (Yes)

Not Applicable

Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


6.

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?

No (No)

Yes

Date(s)

7.

Details

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; a. b. c.

Your client/any member of the public Not Applicable Your Professional Body Not Applicable Any other lawful authority or body Not Applicable

Date(s)

8.

Details

Is there any additional information which should be brought to the attention of Independent Electoral and Boundaries Commission which might call into question your eligibility for the above post in IEBC? No (No) Date(s)

Yes Details

Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


X

PERSONAL REFERENCES

Give the names and addresses of three 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 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 the Independent Electoral and Boundaries Commission.

1.

Pastor Ombori Odundo Ongilo Name……………………………………………………………………………….. Box 255- 40305, Mbita Address…..………………………………………………………………………… Pastor/Teacher Occupation ........................................................................................................................ ombori11@yahoo.com Email…………………………………………………………………………………….. 0724149362 Telephone………………………………………………………………......................... 2007 to date Period during which he/she has known you ...............................................................

2.

Everline Ochome Name……………………………………………………………………………….. Address…..………………………………………………………………………… Box 158-40107, Muhoroni

Teacher

Occupation ........................................................................................................................

eochome@yahoo.com Email…………………………………………………………………………………….. 0725637354 Telephone………………………………………………………………......................... 2005 todate Period during which he/she has known you ...............................................................

3.

Peter Otieno Otare Name……………………………………………………………………………….. Box Address…..………………………………………………………………………… Deputy Principal/Teacher

Occupation ........................................................................................................................

potareh@gmail.com Email…………………………………………………………………………………….. 0710449004

Telephone……………………………………………………………….........................

2002 todate Period during which he/she has known you ...............................................................

DECLARATIONS Our Tel: +254-020-2769000, Fax: +254-020-2219185, e-mail: recruit@iebc.or.ke, www.iebc.or.ke


1. Declaration of interest

(The fact of an applicant declaring interest in section 1(a) or 1(b) will not necessarily debar him/her from employment in IEBC. Each case will be considered on its own merit having regard to the nature of the relationship or affiliation as the case may be). 1. a) Are you related in any way to any member or staff of the Commission? If so, please give details below:

No

b) Are you in any way affiliated to any political party as an official, activist or member? If so, please give details below:

No

2. Final declaration I declare that: i)

The information I have given on this form is true to the best of my knowledge and belief;

ii)

I have read and understood the “notes for candidates” at the end of this form and (if completing this form electronically), I certify that the ‘typed’ signature is intended to be my signature.

iii)

Any incorrect information may lead to disqualification/legal action.

iv)

If I am completing this form electronically, I certify that the ‘typed’ signature is intended to be my signature.

Rawlings Jumah Angirah Names of applicant:……………………………………………………………………… 27-3-2012

J.A.R Signature of applicant:………………………………Date: …………………………………………


XII

NOTES FOR CANDIDATES

1.

Please make sure you have completed all sections of this document.

2.

It is a serious offence to willfully give false information on this form.

3.

Do not apply for any post unless you possess all the qualification given in the advertisement.

4.

Send this form with all other required documents as per instructions in the advertisement to: The Chief Executive Officer / Commission Secretary Independent Electoral and Boundaries Commission, P.O. Box 45371 - 00100 Nairobi, Kenya AND/OR Fill the Electronic form provided on the website (www.iebc.or.ke)

5.

Do not enclose originals of your testimonials or certificates but send certified copies. No responsibility can be accepted by the Independent Electoral and Boundaries Commission for the custody of original documents unless a specific request has been made for their production.

6.

If you are invited to an interview, bring the originals of your testimonials and certificates with you, but make sure that they are returned to you before you leave.

7.

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

8.

Only Shortlisted Candidates will be contacted

9.

Shortlisted candidates will be taken through a vetting process in line with Chapter Six (6) of the Constitution.


ANGIRA RAWLINGS