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INTERNSHIP APPLICATION FORM-1-1

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GILBERT KIPNGETICH
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99 views

INTERNSHIP APPLICATION FORM-1-1

Uploaded by

GILBERT KIPNGETICH
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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State Department for Livestock Development

Directorate of Veterinary Services


INTERNSHIP APPLICATION FORM
Greetings from the Internship office;
The Veterinary Internship Programme is a MANDATORY fifty-two (52) weeks training programme for
all Kenyan Veterinary and Animal Health Graduates from the year 2016 in line with the Veterinary
Surgeons and Veterinary Paraprofessional Act No 29 of 2011 Section 15 (1) and 17 (1).
We have experienced technical issues with the use of Google forms for the application process, and we
apologize for the inconveniences experienced.
As a result, the attached word document version of the form has been developed to aid your application
process for the 2024/2025 cohort.
Please fill out the form as required and submit it via the following email address:
[email protected]

IMPORTANT INSTRUCTIONS FOR APPLICANTS


1. This form must be filled by all eligible interns for the 2024/2025 internship period. The required
documents MUST be attached together with the filled application form to the email provided.
This also applies to those who had applied earlier via the Google form link, and those who had
applied physically at the DVS Internship office.
2. Before filling this form, ensure that you have obtained temporary registration as an intern from
the Kenya Veterinary Board.
3. Make sure to double-check your entries before submitting and ensure the form and the other
required documents are properly attached to your email. If you encounter any issues with the
form or submission process, please reach out for assistance via the email address provided.
4. A list of KVB approved Internship Centres has been provided in a separate document attached to
this email. Please select only one, and indicate it in the application form.
5. A list of ethnic groups has also been included in the attached document. Please select the
appropriate ethnic group which you belong and indicate it in the application form.
6. To assist in the processing of your stipend, please attach scanned copies of the following
documents to the email:
i. National Identification Card (ID);
ii. Birth Certificate;
iii. Passport photo;
iv. KRA Pin certificate.
7. NB: The deadline for submitting the application has been further extended to the 13th December,
2024.
8. For any inquiries, please write an email to: [email protected] or call this number:
0208043441
Thank you for your cooperation, and we look forward to receiving your completed application.

EMAIL: [email protected]

Full name as it appears in your National Joan Chepkorir Rotich


Identity card
(First, Middle, Surname):

National ID Number: 34335455

Birth Certificate Entry Number: 0611004492

KRA PIN Number: A011036516C

Gender: ☐ MALE  FEMALE

Are you a person living with Disability: ☐ YES  NO

Date of Birth (DD/MM/YY) 02/24/1995. Click or tap here to enter text.


e.g. 12/30/2000:

Mobile Number: 0725790585

Full Name of Next of Kin: GILBERT KIPLANGAT KOECH.

Mobile Number of Next of Kin: 0700783503.

County of Birth BOMET.


(As indicated in your national identity
card):

Name of your Sub County: SOTIK.

Name of your Village: KIMAWIT.

Your Ethnicity (Tribe) KALENJIN.


{Choose from the attached document}:

Level of Training CERTIFICATE. Click or tap here to enter text.


(Either in BVM, BSc., Diploma,
Certificate):

Name of University/College attended AHITI KABETE.


(KVB approved training institutions
only)
{Choose from the list provided};

Year of Graduation: 18TH OCTOBER 2024.

KVB intern number KVB/INT/VPP/007444


(Write it as it appears on the certificate
of registration as an intern issued by
KVB. E.g. KVB/INT/VPP/XXXX for
para-vets OR KVB/INT/VS/XXXX for
Veterinary Surgeons:

Where do you prefer to undertake your .KONOIN SUB-COUNTY


internship?
(Choose from the list provided)

Name of Bank where you hold an KCB BANK.


account:

Bank branch where account was opened: LITEIN.

Bank Account Number: 1334798907

Account Name (Your name as it appears JOAN CHEPKORIR ROTICH.


in your bank account):

Are you a serving or retired Civil ☐ YES  NO


Servant? (Providing wrong information
in this field may lead to prosecution):

Have you ever been allocated a YES Enter your Personal Number if
Government Personal Number (If you  NO applicable
ever worked for the National or County
Government or attended the Public If YES provide the personal Click or tap here to enter text.
Service Internship Programme) number

Social Heath Insurance Fund (SHIF) CR4056012040430-6


Membership Number:

National Social Security Fund (NSSF) 2027956296.


Membership Number:

THE END
THANK YOU FOR APPLYING TO THE
DIRECTORATE OF VETERINARY SERVICES!

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