navy edited.pdf

NIGERIAN NAVYDirect Short Service Commission – Course 23

Application FormPage:1

1 Particulars of Candidate.Application Number:

Department:

Specialisation:

Exam Centre:

Title: Surname:

First Name: Other Names:

Date of Birth:

Town: LGA of Origin:

State of Origin: Height (meters):

Gender: Religion:

Marital Status: No. of Children:

Mobile: E-mail:

Residential Address:

Contact Address:

Hobbies: Tribal Marks: Tattoo/Body Marks:

2 Next of Kin's InformationFull Name: Relationship:

Contact Address:

Occupation: Post:

Phone Number: Email:

3 Parent's / Guardian's InformationFull Name:


4 Education InformationLevel School Qualification Started Finished

Primary 1.

2.

Secondary 1.

2.

Tertiary 1.

Grade:

2.

Grade:

DSS/IM/621/0010351

Music

Abuja - Command Day Secondary School, Mogadishu Barracks

Mr Osuji

Prince Ugochukwu

25-Mar-1988

Male Christianity

Single

08061208877 [email protected]

No 39, Assemblies of God Str, off NYSC, Kubwa. Abuja.

11th Floor, Radio House. Garki Abuja.

Playing of music instruments, Swimming. No No

Osuji Nnamdi Brother

No 4 Anazonwu str, Opp Fed. Govt Girls College, 3-3. Onitsha. Anambra state.

Doctor

08061171690

Mr Osuji Jerome Obinna

No 4 Anazonwu str, Opp Fed. Govt Girls College, 3-3. Onitsha. Anambra state.

Redemption Nursery and Primary School, Onitsha.First School Leaving Certificate1993 1999

Maranatha International Secondary School. Onitsha.Senoir School Certificate Examination1999 2006

University of Nigeria, Nsukka. Enugu State 2009 2013

Second Class Upper

Amawom Owerri Municipal

Imo 1.90



SSCE / GCE / WASSCE / NECO Result Sitting(s)

1 English Language 6

2 7

3 8

4 9

5 10

Additional Qualification / Special Skills / Job Experience

5 Referee's Information (2 Referees)

Full Name: Phone:

Contact Address:

Full Name: Phone:

Contact Address:

6 Further Information

Do you possess previous work experience?

Number of Years of Experience:

Have you ever served in the Armed Forces or any other security agency?

Give details (if Yes):

Reason for leaving:

Have you ever been detained by the Police?

State reason (if Yes):

Duration of detention:

Have you ever been convicted by a Court of Law?

State reason (if Yes):

Conviction:

Do you suffer from any physical or mental disability?

Nature of Disability (if Yes):

Have you ever been admitted in a hospital?

Nature of illness (if Yes):

1

B2 Physics C6

Maths B3 Literature B3

Chemistry B3

Music A1

C4Geography

Lieutenant Osuji John 08060519424

Gowon Estate, Egbeda, Lagos State.

Prof (Mrs) S.C Makinde 08035883377

NAPTIP, Wuse 5. Abuja

Yes

3 years.

No

No

No

No

No

Orchestra Conductor University of Nigeria, Nsukka (2011 - 2013).Band Director, Western Instrumental Ensemble, UNN (2012 - 2013)Performing Arts, Orchestration, Composition and Musical instrumentation.



APPLICANT'S DECLARATION

Application Number:

Signature: Date:

Certification by Parents / Guardian

Parent / Guardian Witness

Name: Name:

Address: Address:

Signature: Signature:

Date: Date:

DSS/IM/621/0010351

I OSUJI PRINCE UGOCHUKWU, hereby declare that the information given in this application is trueand that if found to be false I should be prosecuted.

I ____________________________________________________ parent/guardian of OSUJI PRINCEUGOCHUKWU, who is applying for recruitment into the Nigerian Navy, hereby certify that I fullyunderstand that my child/ward will (if required to) attend the Recruitment Exercise and I shall notdemand compensation or relief from the Government in respect of death or any injury which mychild/ward may sustain in the course of or as a result of any task given to him/her during theexercise.



LOCAL GOVERNMENT AREA

CERTIFICATION

Particulars of Candidate.Application Number:

Title: Surname:


Date of Birth:



Gender: Religion:

Mobile: E-mail:


Contact Address:

Certification by LGA Chairman / Secretary Or Senior Military Officer not below therank of Commander or equivalent Or Chief Superintendent of Police from

Applicant's State of Origin

Name:

Address:

Signature (Council Stamp):

Date:

DSS/IM/621/0010351

Mr Osuji

Prince Ugochukwu

25-Mar-1988

Male Christianity




I certify that the applicant OSUJI PRINCE UGOCHUKWU is an indigene of Amawom Town, OwerriMunicipal L.G.A, Imo State, and that to the best of my knowledge and belief, the facts stated onthe form are correct.

I hereby declare that if any statement made in connection with this application is proven to befalse I should be prosecuted.


Imo 1.80



POLICE CERTIFICATION

Particulars of Candidate.Application Number:

Title: Surname:


Date of Birth:



Gender: Religion:

Mobile: E-mail:


Contact Address:

Certification by Divisional Police Officer

Name:

Address:

Signature:

Date:

DSS/IM/621/0010351

Mr Osuji

Prince Ugochukwu

25-Mar-1988

Male Christianity




I certify that the applicant OSUJI PRINCE UGOCHUKWU is an indigene of Amawom Town, OwerriMunicipal L.G.A, Imo State and that his/her parent hails from Owerri Municipal L.G.A. of ImoState. That he/she has no criminal record on him/her. (If any state briefly________________________________________________________________________________________________________________________________________________________________________________________).

That to the best of my knowledge and belief the facts stated in the form are correct and Ihereby declare that if any statement made in connection with this application is proven to befalse I should be prosecuted.


Imo 1.80



GUARANTOR'S FORM

1 Particulars of Candidate.Application Number:

Title: Surname:


Date of Birth:



Gender: Religion:

Mobile: E-mail:


Contact Address:

2 Particulars of Guarantor

Surname: ______________________________________ First Name: ____________________________________

Middle Name: _________________________________ Town: _________________________________________

LGA: __________________________________________ State of Origin: ________________________________

Mobile: ________________________________________ E-mail: ________________________________________

Appointment: __________________________________ How long have you known the candidate:_______

Formation/Unit/Office Address: _________________________________________________________________

Residential Address: ___________________________________________________________________________

Contact Address: ______________________________________________________________________________

Name:

Rank/Appointment:

Signature:

Date/Stamp:

Note:

This form is to be filled by a Military Officer not below the rank of Lt Col or equivalent/Police Officer not below the rank of Chief Superintendent of Police/Assistant Director at either Federal or State Civil Service certifying the eligibility of the applicant. You need not to come from an applicant’s State of Origin to guarantee him/her only be sure of the character. Please note that inability to confirm the above given information about you, will lead to automatic disqualification of the candidate.

DSS/IM/621/0010351

Mr Osuji

Prince Ugochukwu

25-Mar-1988

Male Christianity





Imo 1.80



FOR OFFICIAL USE ONLY

Application Number:

Applicant's Full Name:

Date Received:

Education Qualification:

Number Of Credits/Passes obtained (SSCE / GCE / WASSCE / NECO):

Documents Attached

a)

b)

c)

d)

e)

Detailed Resulta)Medical fitness:

b)General aptitude test score:

c)Vocational aptitude test score:

Remarks

a)Rank:

b)Name:

c)Signature and Date:

Director, Manning

a)Rank:

b)Name:

c)Signature and Date:

DSS/IM/621/0010351

OSUJI PRINCE UGOCHUKWU