Application Form
Application Number National Identification Number Bank Verification Number
NNR37/2024/IMO/220/0025424 89070056352 22694846173
Category Exam State Exam Center
Aircraft Engineering Artificers Imo 34 ARTY BDE OBINZE
(Avionics & Aircraft Electrics
Electrical/Electronics) - A4
Title Surname First Name
Mr Obioma Wisdom
Other Name Height Religion
none 1.78 Christianity
Marital Status Gender Date Of Birth
Single M Sunday, February 9, 2003
State of Origin LGA of Origin Mobile Number
Imo Mbaitoli 09015425949
Home Town Permanent Address
Owerri. umunkwodu ,umunjam,mbieri.
Parent/ Guardian Detail
Full Name Contact Address
Ihemedu Obioma Rufus. Umunkwodu,umunjam, mbieri.
Next Of Kin
Full Name Relationship Mobile Number
Ejimole, Odiwomma, peace. sister +234 816 070 8439
Occupation Contact Address
Self employed Crystal Fountain avenue, off akwakuma.
Application Form
Referee Details
Referee Name Phone Referee Address
Ejimole Odiwomma peace +234 816 070 8439 Crystal Fountain avenue, off Akwakuma.
Ihemedu,chidiukwu, prince. 07043647698 umunjam mbieri.
Primary Details
School Qualification From To
God's covenant nursery and primary school. fslc 2007 2014
Secondary Details
School Qualification From To
God's covenant nursery and primary school. waec 2014 2020
SSCE / NECO / WASSCE / GCE
Subject Grade Examination
Mathematics B3 GOOD 4011510177
English C4 CREDIT 4011510177
Physics B2 VERY GOOD 4011510177
Chemistry B3 GOOD 4011510177
Biology B3 GOOD 4011510177
Tertiary Details
Institution Course of Study Type From To Grade
Application Form
LOCAL GOVERNMENT AREA CERTIFICATION
Application Number
NNR37/2024/IMO/220/0025424
Title Surname First Name
Mr Obioma Wisdom
Other Name Height Religion
none 1.78 Christianity
Marital Status Gender Date Of Birth
Single M Sunday, February 9, 2003
State of Origin LGA of Origin Mobile Number
Imo Mbaitoli 09015425949
Home Town Permanent Address
Owerri. umunkwodu ,umunjam,mbieri.
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
NNR37/2024/IMO/220/0025424
Title Surname First Name
Mr Obioma Wisdom
Other Name Height Religion
none 1.78 Christianity
Marital Status Gender Date Of Birth
Single M Sunday, February 9, 2003
State of Origin LGA of Origin Mobile Number
Imo Mbaitoli 09015425949
Home Town Permanent Address
Owerri. umunkwodu ,umunjam,mbieri.
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 Certification
Application Number
NNR37/2024/IMO/220/0025424
Title Surname First Name
Mr Obioma Wisdom
Other Name Height Religion
none 1.78 Christianity
Marital Status Gender Date Of Birth
Single M Sunday, February 9, 2003
State of Origin LGA of Origin Mobile Number
Imo Mbaitoli 09015425949
Home Town Permanent Address
Owerri. umunkwodu ,umunjam,mbieri.
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: NNR37/2024/IMO/220/0025424
Applicant's Full Name: Obioma Wisdom
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:_____________________________________________________
