| CONFIRMATION OF TRAINNING REQUEST Name of the applicant | NSO IMAOBONG BASSEY Date of Birth 1774 MARCH,1978 |Current Home Address _| 73 VICTORY WAY, SATELIGHT TOWN, CALABAR, CROSS RIVER STATE, NIGERIA of applicant ‘Job Reference Number | CYG22611 Please confirm study From: ] To: dates JULY,2016 | | FEBRUARY,2022 | Please confirm the — course on which the BNSc BACHELOR OF NURSING SCIENCE applicant was registered ‘Was the above named person subject to any disciplinary or given any warnings about their conduct during the time they were on the course specified above? | Yes] | No [Ee Ifyes please give detail 2. Are you aware of any recent allegations or outstanding allegations which were made against the applicant than relate to any safeguarding issues/referrals | Yes [] No {including any referrals made to the Disclosure and Barring Service or Independent Safeguarding Authority)? Ifyes please give details Declaration ‘The answers given above have been provided in good faith and are correct to the best of my knowledge and belicf Referee Name (Please print): Signature: PROFESSOR ONYEKA IWUCHUKWU | Email Address: Telephone Number: a calabarstudycentre@noun.edu.ng +2347032760885 Date | 7" OCTOBER,2022 Data Protection: ‘This form contains personal data as defined by the data protection Act. This data has been requested by the resourcing Department exclusively for the purpose of recruitment. The Resourcing Department must protect any information disclosed within this form and ensure that it fs not passed to anyone whois not authorised to have this information