Application Form

Application Number National Identification Number Department

DSSC29/2024/ENU/883/0058831 13282364996 MEDICAL

Specialization Exam State Exam Center

Social Welfare Officer/Nutritionist Owerrinta Nigerian Navy College of Accounts
and Finance, Owerrinta

Title Surname First Name

Mr Orjionuchie Okechukwu

Other Name Height Religion

David 1.67 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, February 3, 1998

State of Origin LGA of Origin Mobile Number

Enugu Awgu 09031707946

Permanent Address Contact Address

24 amurri road, abakpa Nike Enugu,

Parent/ Guardian Detail

Full Name Contact Address

Orjionuchie Simon 24 amurri road, abakpa Nike Enugu,

Next Of Kin

Full Name Relationship Mobile Number

Orjionuchie Nnabuike Brother 09049952217

Occupation Contact Address

Student 24 amurri road abakpa nike Enugu Enugu state Nigeria
 Application Form
Referee Details

Referee Name Phone Referee Address

Simon 08037121590 24 amurri road abakpa nike Enugu Enugu state Nigeria

Jideofor Joy 08039470236 24 amurri road abakpa nike Enugu Enugu state Nigeria

Primary Details
School Qualification From To

Holy cross Primary school abakpa nike Enugu fslc 2003 2009

Secondary Details

School Qualification From To

Holy cross Primary school abakpa nike Enugu waec 2009 2015

SSCE / NECO / WASSCE / GCE

Subject Grade Examination

Mathematics C6 CREDIT 4150322143

English C4 CREDIT 4150322143

Physics C5 CREDIT 4150322143

Chemistry C5 CREDIT 4150322143

Biology C6 CREDIT 4150322143

Agricultural Science B3 GOOD 4150322143

Economics C6 CREDIT 4150322143

Igbo B3 GOOD 4150322143

Civic Education A1 EXCELLENT 4150322143

Tertiary Details
Institution Course of Study Type From To Grade

University of Nigeria Nsukka Biochemistry bachelor 2016 2021 upper_credit

 Application Form
APPLICANT'S DECLARATION

Application Number
DSSC29/2024/ENU/883/0058831

Application Number: DSSC29/2024/ENU/883/0058831

I Orjionuchie Okechukwu , hereby declare that the information given in this application is true and that if found to be
false I should be prosecuted.

Signature: _______________________________ Date: _______________________________

Certification by Parents / Guardian

I _____________________________________ parent/guardian of ______________________________________, who is applying for

recruitment into the Nigerian Navy, hereby certify that I fully understand that my child/ward will (if required to) attend
the Recruitment Exercise and I shall not demand compensation or relief from the Government in respect of death or
any injury which my child/ward may sustain in the course of or as a result of any task given to him/her during the
exercise.
Parent / Guardian Witness
Name: _________________________________ Name: _________________________________
Address: _______________________________ Address: _______________________________
Signature: _______________________________ Signature: _______________________________
Date:_______________________________ Date:_______________________________
 Application Form
LOCAL GOVERNMENT AREA CERTIFICATION

Application Number
DSSC29/2024/ENU/883/0058831

Title Surname First Name

Mr Orjionuchie Okechukwu

Other Name Height Religion

David 1.67 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, February 3, 1998

State of Origin LGA of Origin Mobile Number

Enugu Awgu 09031707946

Permanent Address Contact Address

24 amurri road, abakpa Nike Enugu,

Certification by LGA Chairman / Secretary Or Senior Military Officer not

below the rank of Commander or equivalent Or Chief Superintendent Of
Police from Applicant's State of Origin

I certify that the applicant ____________________________________________ is an indigene of _____________________________

L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct.
I hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.

Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
 Application Form
POLICE CERTIFICATION

Application Number
DSSC29/2024/ENU/883/0058831

Title Surname First Name

Mr Orjionuchie Okechukwu

Other Name Height Religion

David 1.67 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, February 3, 1998

State of Origin LGA of Origin Mobile Number

Enugu Awgu 09031707946

Permanent Address Contact Address

24 amurri road, abakpa Nike Enugu,

Certification by LGA Chairman / Secretary Or Senior Military Officer not below the rank of
Commander or equivalent Or Chief Superintendent Of Police from Applicant's State of
Origin
I certify that the applicant ____________________________________________ is an indigene of _____________________________
L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct.
I hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.
Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
Certification by Divisional Police Officer
I certify that the applicant _________________________________ is an indigene of ______________________Town,
_________________________ L.G.A, ________________ State and that his/her parent hails from __________________________ L.G.A.
of _________________ State. That he/she has no criminal record on him/her. (If any state briefly
___________________________________________________________________________________________________________________________________
That to the best of my knowledge and belief the facts stated in the form are correct and I hereby declare that if any
statement made in connection with this application is proven to be false I should be prosecuted.

Name:_______________________________
Address:_______________________________
Signature:_______________________________
Date:_______________________________
 GUARANTOR'S FORM

Application Number
DSSC29/2024/ENU/883/0058831

Title Surname First Name

Mr Orjionuchie Okechukwu

Other Name Height Religion

David 1.67 Christianity

Marital Status Gender Date Of Birth

Single M Tuesday, February 3, 1998

State of Origin LGA of Origin Mobile Number

Enugu Awgu 09031707946

Permanent Address Contact Address

24 amurri road, abakpa Nike Enugu,

Particulars of Guarantor

Surname: ______________________________________ First Name: ____________________________________

Middle Name: _________________________________ Town: _________________________________________
LGA: __________________________________________ State of Origin: ________________________________
Mobile: ________________________________________ E-mail: ________________________________________
Appointment: __________________________________ How long have you known the candidate:_______
Formation/Unit/Office Address: _________________________________________________________________
Residential Address: ___________________________________________________________________________
Contact Address: ______________________________________________________________________________
Name: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________

This form is to be filled by a Military Officer not below the rank of Lt Col or equivalent/Police Officer not below
the rank of Chief Superintendent of Police/Assistant Director at either Federal or State Civil Service certifying
the eligibility of the applicant. You need not to come from an applicant’s State of Origin to guarantee him/her only be
sure of the character. Please note that inability to confirm the above given information about you, will lead to
automatic disqualification of the candidate.
 Application Form
FOR OFFICIAL USE ONLY

Application Number: DSSC29/2024/ENU/883/0058831

Applicant's Full Name: Orjionuchie Okechukwu
Date Received:_____________________________________
Education Qualification: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical fitness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________

Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________