Application Form

Particulars of Candidate.

Application Number: NNR33/2022/KAN/7453/0123184

National Identification Number: 59263563815

Bank Verification Number: 22440613035

Department: Store Assistant

Exam Centre: Kaduna

Center Location: HQ 1 DIV NA KADUNA

Title: MR Surname: SAMINU

First Name: AUWALU Other Name: ABDUSSALAM

Religion: Islam Marital Status: Single

Gender: Male Date Of Birth: 6/19/1995

State of Origin: KANO LGA of Origin: Takai

Home Town: Mobile Number: 09131656462

Height(Meters): 1.69 No. of Children: 0

Hobbies: WATCHING FOOTBALL Email:

[email protected]

Permanent Address BAKIN KASUWA, TAKAI

Contact Address BAKIN KASUWA, TAKAI

 Application Form

Next of Kin's Information

Full Name: SAMINU ABDUSSALAM Relationship: FATHER

Occupation: DOCTOR Mobile Number: 08036184707

Email: [email protected] Post:

Contact Address: BAKIN KASUWA, TAKAI

Parent's / Guardian's Information

Full Name: 08036184707

Residential Address: BAKIN KASUWA, TAKAI

Referees

Referee Name Referee Address Referee Phone

SAMINU ABDU TAKAI BAKIN KASUWA, TAKAI 08036184707

DR.MUSA GAMBO TAKAI BAKIN KASUWA, TAKAI 08035699863

Education Information

Primary Details

School Qualification From To

TAKAI SPECIAL PRIMARY SCHOOL CERTIFICATE 2000 2006

Secondary Details

School Qualification From To

GOVERNMENT SECONDARY SCHOOL, TAKAI WAEC AND NECO 2006 2012

Tertiary Details

Institution Course of Study Type From To Classification

JIGAWA STATE POLYTECHNIC PUBLIC OND 2013 2016 Pass

DUTSE ADMINISTRATION
 Application Form

SSCE / NECO / WASSCE / GCE

No. of sittings: Exam Number 1:

Subject Grade Examination

English C6 CREDIT 4203002173

Geography C5 CREDIT 60854494CE

Economics C4 CREDIT 60854494CE

Mathematics C5 CREDIT 4203002173

Civic Education C5 CREDIT 60854494CE

 Application Form

Have you taken Covid19 Vaccine? Yes

Have you ever served in the Armed Forces or any other security agency?No
Give details (if Yes):

Reason for leaving:

Have you suffered any mental illness before? No

Give details (if Yes):

Do you have any disability? No

Give details (if Yes):

Have you ever been convicted by a Court of Law? No

State reason (if Yes):

Conviction:

Do you have any relative(s) serving or that served in the Armed Forces?

Full Name: Force:

Last Rank: Still in service?:

Full Name: Force:

Last Rank: Still in service?:

 Application Form
APPLICANT'S DECLARATION

Application Number: NNR33/2022/KAN/7453/0123184

I SAMINU AUWALU, hereby declare that the information given in this application is true and that if found to be
false I should be prosecuted.

Signature: _______________________________ Date: _______________________________

 Application Form
Consent by Parent/Guardian

Application Number: NNR33/2022/KAN/7453/0123184

I _____________________________________ parent/guardian of ______________________________________, who is applying

for recruitment into the Nigerian Navy, hereby certify that I fully understand that my child/ward will (if required to)
attend the Recruitment Exercise and I shall not demand compensation or relief from the Government in respect of
death or any injury which my child/ward may sustain in the course of or as a result of any task given to him/her
during the exercise.

Parent / Guardian Witness

Name: _________________________________ Name: _________________________________

Address: _______________________________ Address: _______________________________

Signature: _______________________________ Signature: _______________________________

Date:_______________________________ Date:_______________________________
 Application Form
LOCAL GOVERNMENT AREA CERTIFICATION

Application Number: NNR33/2022/KAN/7453/0123184

Title: MR Surname: SAMINU

First Name AUWALU Other Name ABDUSSALAM

Religion Islam Marital Status Single

Date Of Birth: Monday, June 19, 1995 Gender Male

State of Origin: KANO LGA of Origin: Takai

Home Town Mobile Number 09131656462

Height(Meters) 1.69 Email:

[email protected]

Permanent Address BAKIN KASUWA, TAKAI

Certification by LGA Chairman / Secretary Or Senior Military Officer not below the rank of Commander or
equivalent Or Chief Superintendent Of Police from Applicant's State of Origin

I certify that the applicant ___________________________________ is an indigene of _______________________ L.G.A,

________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct. I
hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.

Name:_________________________________________

Address:_________________________________________________________________

Signature:_________________________________________

Date:_________________________________________
 Application Form
POLICE CERTIFICATION

Application Number: NNR33/2022/KAN/7453/0123184

Title: MR Surname: SAMINU

First Name AUWALU Other Name ABDUSSALAM

Religion Islam Marital Status Single

Date Of Birth: Monday, June 19, 1995 Gender Male

State of Origin: KANO LGA of Origin: Takai

Home Town Mobile Number 09131656462

Height(Meters) 1.69 Email:

[email protected]

Permanent Address BAKIN KASUWA, TAKAI

Certification by Divisional Police Officer

I certify that the applicant _________________________________ is an indigene of ______________________Town,

_________________________ L.G.A, ________________ State and that his/her parent hails from __________________________
L.G.A. of _________________ State. 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 I hereby declare that if any
statement made in connection with this application is proven to be false I should be prosecuted.

Name:_______________________________

Address:_______________________________

Signature:_______________________________

Date:_______________________________
 GUARANTOR'S FORM

Application Number: NNR33/2022/KAN/7453/0123184

Title: MR Surname: SAMINU

First Name AUWALU Other Name ABDUSSALAM

Religion Islam Marital Status Single

Date Of Birth: Monday, June 19, 1995 Gender Male

State of Origin: KANO LGA of Origin: Takai

Home Town Mobile Number 09131656462

Height(Meters) 1.69 Email:

[email protected]

Permanent Address BAKIN KASUWA, TAKAI

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: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________
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.
 Application Form
FOR OFFICIAL USE ONLY

Application Number: NNR33/2022/KAN/7453/0123184

Applicant's Full Name: SAMINU AUWALU
Date Received:_____________________________________
Education Qualification: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical fitness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director, DRRR
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________