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Kwale County Ministry of Health and KEMRI Application for TUMIKIA Field Officer Post Q1. APPLICANT Full name Title Mr/Mrs/Ms/Dr Date of birth Full postal address Nationality Telephone Mobile E-mail address Q2. Secondary school education qualifications Name and address of High School Grade Attained Year of completion Q3. University/College Education if applicable Name of College/University Date of graduation Subject of Certificate/Diploma/ degree Q4. Your most recent post and two other posts you have held particularly relevant to this position list the most recent first Dates Position Organization Q 5. Do you have any experience in fieldwork or work in the communities Provide details. Q 8. List any relevant courses or training you have undertaken* Q9. Describe what personal qualities you think make a good field officer and why you think you would make a good candidate for this position Max 150 words Q10. Languages spoken Level fluent proficient NAME OF THREE REFEREES Please provide the names of three referees who may be approached Referee 1 Institution s address Completed forms should be returned by email to tumikiaproject gmail*com* The email subject line should be marked TUMIKIA Field Officer. Secondary school education qualifications Name and address of High School Grade Attained Year of completion Q3. University/College Education if applicable Name of College/University Date of graduation Subject of Certificate/Diploma/ degree Q4. University/College Education if applicable Name of College/University Date of graduation Subject of Certificate/Diploma/ degree Q4. Your most recent post and two other posts you have held particularly relevant to this position list the most recent first Dates Position Organization Q 5. Your most recent post and two other posts you have held particularly relevant to this position list the most recent first Dates Position Organization Q 5. Do you have any experience in fieldwork or work in the communities Provide details. Q 8. List any relevant courses or training you have undertaken* Q9. Do you have any experience in fieldwork or work in the communities Provide details. Q 8. List any relevant courses or training you have undertaken* Q9. Describe what personal qualities you think make a good field officer and why you think you would make a good candidate for this position Max 150 words Q10. Describe what personal qualities you think make a good field officer and why you think you would make a good candidate for this position Max 150 words Q10. Languages spoken Level fluent proficient NAME OF THREE REFEREES Please provide the names of three referees who may be approached Referee 1 Institution s address Completed forms should be returned by email to tumikiaproject gmail*com* The email subject line should be marked TUMIKIA Field Officer. Secondary school education qualifications Name and address of High School Grade Attained Year of completion Q3. University/College Education if applicable Name of College/University Date of graduation Subject of Certificate/Diploma/ degree Q4. Your most recent post and two other posts you have held particularly relevant to this position list the most recent first Dates Position Organization Q 5.

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