Separate Application Form To Be Used For Different Posts

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MAURITIUS INSTITUTE OF EDUCATION

Rduit, Mauritius
Telephone: 401 6555
Fax: 454 10 37
Web Site: www.mieonline.org

For Office Use Only


Application No.:
Q
NQ
P

APPLICATION FORM
(PLEASE COMPLETE THIS FORM IN 2 COPIES AND WRITE CLEARLY IN INK)

Separate application form to be used for different posts


1.

Post applied for:

2.

National Identity Card No.:

3.

Title:

Mr

4.

Surname:

.......................................................................................................

Mrs

Miss

Other name(s): ........................................................................................................


Maiden name (if applicable):
5.

Block
Letters

..............................................................................

Residential Address:
.................................................................................................
E-mail Address:

Telephone No: Home: .........................


Date of birth:

6.

Mobile: .........................
Age:

Office: ........................

Nationality: ...............................

Education
Names of secondary schools attended: .................................................................................
SC/GCE O Level
1st attempt
2nd Attempt
3rd Attempt
Results
Date of Attempt (Month/Year)
Subjects
Grades (e.g. 1, 2, 3 ... or A, B, C ...)

1st attempt

HSC/GCE A Level
Results
Date of Attempt (Month/Year)
Subjects taken at Principal Level

3rd Attempt

Grades (A, B, C ...)

Subjects taken at Subsidiary Level

7.

2nd Attempt

Grades (e.g. 1, 2, 3 ... or A, B, C ...)

Post Secondary Qualifications


Courses/Programmes

Institutions

Grade Awarded (if

Duration

From

To

degree, state class and


whether with Honours)

1
2
3
4
5
8.

Employment History
(a)

Present Employer: .....................................................................................................................


Present Position held: .......................................................

From: To:.

Institution/Secondary School:...
Present Salary: ............................
(b)

Previous Employment

Name of Employer

Period
From

9.

Period of notice required by employer: ....................

Post held
To

Other courses, seminars, etc (if any) attended. (Give details, including dates)
.........................................................................................................................................................

.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
10.

Indicate
a.
Any important articles, books, etc, which you have published or contributed to:
............................................................................................................................................
............................................................................................................................................
b.

Hobbies, sports, interests and any other matters you would wish to bring to the attention of the
Institute
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................

11.

Referees
Referee 1

Referee 2

Name: ................................................................

Name: ................................................................

Occupation: .........................................................

Occupation: .........................................................

Address: ..............................................................

Address: ..............................................................

.............................................................................

.............................................................................

Phone No.: .........................................................

Phone No.: .........................................................

(N.B Please obtain their prior agreement to act as referees)

Declaration
I, ..........................................................................................................................................., the
undersigned applicant declare that the particulars in this application form are true and accurate and that I
have not willfully suppressed any material fact.
Date: ............................................

Signature: ................................................

NB: Incomplete and inaccurate filling of the form and not supported by relevant documents may entail
elimination of candidates.

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