GEOTHERMAL DEVELOPMENT COMPANY

APPLICATION FOR ATTACHMENT AND INTERNSHIP PROGRAMMES FORM

Please complete this form in BLOCK LETTERS and submit to any GDC office i.e.
Nairobi, Central Rift (Nakuru) or North Rift (Baringo) South Rift (Naivasha).

Type of Programme.. (Internship………………….…..Attachment…………………..).

If Attachment (Tick option) Period

July 2019 - September 2019 …..………….
October 2019 - December 2019 …..………….
January 2020 - March 2020 …..………….
April 2020 - June 2020 …..………….
1. Full Name………………………………………………………………………………….
2. Date of Birth……………………………………………….................................................
3. National Identity Card Number*…….…………………………………………..........
4. Gender……………………………………………………………………………………..
5. NSSF No*………………………………NHIF No*…………………………………...
6. KRA PIN No*…..………….…………………………………………………………….
7. Certificate of Good Conduct Number*………............………………………………..
8. Postal Address ………………………..Postal Code……………. Town……………….
9. E-mail Address……………………………………………………………………………
10. Mobile Number…………………………………………………………………………...
11. Home County ………………………………………….Sub-County……...……………
12. Ethnicity…………………………………………………………………………………...
13. Disability Status ……………………………..NCPWD Registration No*…………..
14. Educational/Professional Qualifications
Accredited Institution of Learning ………………………………………………………
Level of Education ………………………………………………………
Course ………………………………………………………
Course Specialization ………………………………………………………
Year of Graduation (Interns only) ………………………………………………………

I certify that the information given above is TRUE to the best of my knowledge.

Name: ……………………………………………………………………………………………...
Signature: …………………………………………………………………………………………
Date: ……………………………………………………………………………………………….
* Kindly ensure to attach copies of the highlighted items for verification.

GDC/HRA/HRD/060/001