COLLEGE OF BUSINESS EDUCATION DAR ES SALAAM/DODOMA/MWANZA

-o(&&&&&& APPLICATION FORM FOR DIPLOMA COURSES ORDINARY DIPLOMA IN BUSINESS ADMINISTRATION(DBA), ACCOUNTANCY(DA), PROCUREMENT&SUPPLIES(DPS), MARKETING(DM), INFORMATION AND COMMUNICATION TECHNOLOGY(DICT) & LEGAL AND INDUSTRIAL METROLOGY (DMET) FULL TIME/NIGHT COLLEGE 201 ! DBA/DA/DPS/DMK/DICT /DMET (Underline the course and Session of your choice) The Rector College of Business Education P.O. Box 1968 D"# $% S"&""'( NOTE) a) $) c) A licant !ust affix a hotogra h on the s ace ro"ided. A for! #ithout a hotogra h #ill not $e considered. lication

AFFIX PHOTO PASSPORT SIZE

This for! #hen co! leted !ust reach the Rector l $% 1*TH +UNE, 201 E"er% a licant !ust a% a non&refunda$le a lication fee of T%,(2-,000/. through Ban' as indicated $elo#( Dar es Salaam Campus: NMB A/C No. 20 !!000"0 Dodoma Campus: NBC A/C No. 02#!0!000$!! M%an&a Campus: NMB A/C No. "!!!!000#2

PART I STUDENT/S DETAILS) 1. ,. SURNAME( )Bloc' *etters)+++++++++++++++..

F0#%1 N"'$% 02 F3&& )Bloc' *etters)+++++++++++++ -OTE( The na!es entered in this for! !ust $e the sa!e as those on %our official Acade!ic certificates. .. 0. 1. /ate of Birth +++++++++++++++++++++. Place of Birth +++++++++++++++++++++ -ationalit% ++++++..B% Birth++++++++++++ B% Registration -o+++++./ate+++++Place+++++++ 1

6. 4. 8. 16. 11. 1,. 1.. 10. 11.

Present Address .+++++++++Tel.23o$ile+++++++++.. Per!anent 5o!e Address++++++++++++++++++ Religion ++++++++++++++++++++++++.. 3arital status ++++++++++++++++++ -u!$er of Children+++++++++++++++.. Present E! lo%er++++++++++++++++.. E! lo%ed as++++++++++++++++++.. 7alar% scale ++++++++++++++++++.. 5a"e %ou e"er $een con"icted of a Cri!inal Offense8 9E72-O :f %es gi"e details++++++++++..

16. 14.

/isa$ilit%27 ecial needs+++++++++++++++++. 7tate of health+++++++++++++++++..

PART II EDUCATIONAL 4UALIFICATION 18. 7chool)s) and College)s) attended S5,66& 6# C6&&$7$% A11$28$8 T9:$%) P#0'"#9/S$5628"#9 C$#10;05"1$ 6<1"02$8 "28 D"1$%

);se a se arate sheet if s ace is insufficient) ,

19. Professional2su$& rofessional <ualifications B689 NABE, NBAA, NBMM $15( S1"7$ 56':&$1$8 C$#10;05"1$% 6<1"02$8 "28 D"1$%

N61$%) :t is i! ortant that co ies of the follo#ing docu!ents )-OT OR:=:-A*) are attached( A lication for! #ithout co ies of certificates #ill not $e considered. Also su$!ission of forged certificates or an% false infor!ation is cri!inal offence and #ill $e dealt #ith according to the la#. )a) )$) )c) )d) -ational >or! >our Exa!inations Certificate 7chool *ea"ing Certificate Birth certificate. An% other rele"ant certificates su -o.14 and 18. orting ?ualifications stated under

PART III ,6.

PRE=IOUS EMPLOYMENT RECORDS

Particulars of %our e! lo%!ent since lea"ing 7chool or College including eriods of training@ a renticeshi @ self&e! lo%!ent or une! lo%!ent. N"'$ "28 F3&& A88#$%% 6; E':&69$# F#6' (M621, "28 Y$"#) T6 (M621, "28 Y$"#) P6%01062(%) H$&8

PART I=

FINANCIAL STATUS

,1. Course fees #ill $e aid $% a) $) 3% e! lo%er )-a!e)++++++++++++++++.. An% other s onsoring organiAation or erson )-a!e) +++++++++++++++++++++

N61$) :f %ou ha"e tic'ed )a) or )$) lease as' %our ros ecti"e s onsor to Co! lete -o. ,1. ,,. EMPLOYER/S/SPONSOR/S CERTIFICATE

)To $e co! leted $% a res onsi$le officer authoriAed $% the OrganiAation2>a!il%) )a) Be+++++++++++++++++++++++++++.+. a ro"e s onsorshi of the a$o"e a licant and here$% confir! that he2she #ill $e released )fro! e! lo%!ent etc) for the ur ose of attending the course for the #hole of the re?uired eriod. Be further confir! that our Cor oration2Co! an%2>a!il%2OrganiAation2 3inistr% #ill s onsor the a licant if acce ted@ and a% the College fees as indicated on the attached sheet@ and as !a% $e a!ended@ fro! ti!e to ti!e. Be also underta'e to confir! that the a licant is h%sicall% fit and that he2she has no cri!inal records to the $est of our 'no#ledge. 7igned+++++++++ -a!e++++++++++++++++++++ Ran'++++++++++++++++++++. On $ehalf of +++++++++++++++++. An% other co!!ents++++++++++++++++++++.. ++++++++++++++++++++++++++++++ : CERT:>9 T5AT T5E :->OR3AT:O- =:CE- ABOCE :7 CORRECT.

)$)

++++++++++++++ 7:=-AT;RE O> T5E 7T;/E-T 0

++++++ /ATE