Application Form

Application Number
NNR37/2024/KAD/11568/0134292
National Identification Number
33832240425
Bank Verification Number
22676016747

Category
Seaman - D1
Exam State
Nasarawa
Exam Center
177 BN KEFFI

Title
Mr
Surname
Zebedi
First Name
Douglas

Other Name
Height
1.78
Religion
Christianity

Marital Status
Single
Gender
M
Date Of Birth
Wednesday, September 15, 2004

State of Origin
Kaduna
LGA of Origin
LGA of Origin
Kauru
Mobile Number
09160070021

Home Town
Kigas chawai
Permanent Address
Nasarawa state aso a pada karu l.g.a

Parent/ Guardian Detail

Full Name
Zebedi Norman
Contact Address
Nasarawa state,karu L.G.A ASO A PADA

Next Of Kin

Full Name
Antibas habila
Relationship
Single
Mobile Number
09019824228

Occupation
School
Contact Address
Kaduna state, kauru L.G.A kigas chawai
 Application Form
Referee Details

Referee Name Phone Referee Address

Zebedi Norman 08026337773 Nasarawa state,karu L.G.A aso A pada

Habila tadi Norman 09119470919 Kaduna state, kauru L.G.A kigas chawai

Primary Details
School Qualification From To

ECWA academy aso pada fslc 2013 2017

Secondary Details

School Qualification From To

Aso diamond international academy,aso pada waec 2017 2023

SSCE / NECO / WASSCE / GCE

Subject Grade Examination

Mathematics C6 CREDIT 4261718075

English C6 CREDIT 4261718075

Physics C6 CREDIT 4261718075

Chemistry C6 CREDIT 4261718075

Agricultural Science B3 GOOD 4261718075

Economics C5 CREDIT 4261718075

Tertiary Details

Institution Course of Study Type From To Grade

 Application Form
APPLICANT'S DECLARATION

Application Number
NNR37/2024/KAD/11568/0134292

Application Number: NNR37/2024/KAD/11568/0134292

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

Signature: _______________________________ Date: _______________________________

Certification by Parents / Guardian

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
NNR37/2024/KAD/11568/0134292

Title
Mr
Surname
Zebedi
First Name
Douglas

Other Name
Height
1.78
Religion
Christianity

Marital Status
Single
Gender
M
Date Of Birth
Wednesday, September 15, 2004

State of Origin
Kaduna
LGA of Origin
Kauru
Mobile Number
09160070021

Home Town
Kigas chawai
Permanent Address
Nasarawa state aso a pada karu l.g.a

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
NNR37/2024/KAD/11568/0134292

Title
Mr
Surname
Zebedi
First Name
Douglas

Other Name
Height
1.78
Religion
Christianity

Marital Status
Single
Gender
M
Date Of Birth
Wednesday, September 15, 2004

State of Origin
Kaduna
LGA of Origin
Kauru
Mobile Number
09160070021

Home Town
Kigas chawai
Permanent Address
Nasarawa state aso a pada karu l.g.a

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:_________________________________________
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 Certification

Application Number
NNR37/2024/KAD/11568/0134292

Title
Mr
Surname
Zebedi
First Name
Douglas

Other Name
Height
1.78
Religion
Christianity

Marital Status
Single
Gender
M
Date Of Birth
Wednesday, September 15, 2004

State of Origin
Kaduna
LGA of Origin
Kauru
Mobile Number
09160070021

Home Town
Kigas chawai
Permanent Address
Nasarawa state aso a pada karu l.g.a

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: NNR37/2024/KAD/11568/0134292

Applicant's Full Name: Zebedi Douglas
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
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________