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G. STAFFING2. Professional Staff Certification and Authorization FormInstructions:a) Complete one (1) Staff Certification and Authorization Form for EACH Professional staff being submitted
b) Attach an UPDATED resume for EACH Professional staff being submitted in the Supplier of Works Application Formc) Submit the original along with a photocopy OR a copy certified, signed, sealed and dated by a Justice of the Peace / Notary Public of Academic Qualification(s) AND/OR Certificate(s) AND/OR License(s). (Unless previously submitted, verified and valid)d) Submit the original along with a photocopy of a picture identification with signature OR a copy certified, signed, sealed and dated by a Justice of the Peace / Notary Public for EACH Professional staff being submitted in the Supplier of Works Application Form. (Example Driver’s License, Employee ID, National ID, Passport etc)3. I _________________________________________________________________ hereby solemnly declare that I am currently (Name of Staff member) employed to ______________________________________________________. My current employment status with the Applicant as at (Name of Supplier of Works Applicant seeking registration with PPC) ____________________________________________________ is in a (Please tick)Full Time Part Time Contractual Date (dd/mm/yyyy) Other __________________(please specify) capacity for registration with the Public Procurement Commission (PPC)
4. I _________________________________________________ agree and certify that all representation / information made in my attached (Name of Staff member) updated resume best describes myself, qualifications and experience to the best of my knowledge. I have provided said Supplier of Works Applicant with my particulars which include(s): (Please tick) Update Resume Academic Qualification(s) Certificate(s) License(s)Signature _________________________________ Signature ____________________ ___________________ (Staff member’s Signature) (Director’s / Authorized representative’s Signature)Date _________________________________ Date _______________________________________ (dd / mm / yyyy) (dd / mm / yyyy) PUBLIC PROCUREMENT COMMISSION – Approved Supplier of Works Grades 1 – 4 Application Form - 03/2019 SECTION 1 Page 8 of 20 G. STAFFING5. Technical (This page may be copied as required to provide information for additional staff members)Technical staff includes: Individuals who have benefited from works related tertiary-level training
At the time of application, individuals who have a formal working relationship with the Supplier of Works Applicant in a capacity such as Consultants, Full-time or Part-time staff
Name of Individual: No. Years with Applicant:a) Name of Professional Registration Board: Year of last registration:b) Name of Professional AssociationNumber of years practicing in profession:Academic Qualifications (eg: Cert., Dip., Bsc., Ma., Msc.) Major Discipline Year Qualified Accrediting Institution / / / / / /General Instructions: iv)i) Complete the table below regarding experience in EACH category of works for which registration is being applied for
v)ii) Attach detailed and updated resume to the Application Form for EACH Professional Staff member submitted. ** vi)iii) Attach Academic Qualification(s) and / or Professional Association Certificate(s) / Licence(s). ** Category Applied for No. of Years Experience in this (List name of category) Category of Work Position Held Project Description** Refer to Section III of the Application Form for the Detailed Requirements for Registration
PUBLIC PROCUREMENT COMMISSION – Approved Supplier of Works Grades 1 – 4 Application Form - 03/2019 SECTION 1 Page 9 of 20 6. Technical Staff Certification and Authorization FormInstructions: a) Complete one (1) Staff Certification and Authorization Form for EACH Technical staff being submitted
b) Attach an UPDATED resume for EACH Professional staff being submitted in the Supplier of Works Application Form c) Submit the original along with a photocopy OR a copy certified, signed, sealed and dated by a Justice of the Peace / Notary Public of Academic Qualification(s) AND/OR Certificate(s) AND/OR License(s). (Unless previously submitted, verified and valid) d) Submit the original along with a photocopy of a picture identification with signature OR a copy certified, signed, sealed and dated by a Justice of the Peace / Notary Public for EACH Technical staff being submitted in the Supplier of Works Application Form. (Example Driver’s License, Employee ID, National ID, Passport etc)7. I _______________________________________________________________hereby solemnly declare that I am currently (Name of Staff member) employed to _________________________________________________________ My current employment status with the Applicant as at (Name of Supplier of Works Applicant seeking registration with PPC) ________________________________________________ is in a (Please tick)Full Time Part Time Contractual Date (dd/mm/yyyy) Other __________________ (please specify) capacity for registration with the Public Procurement Commission (PPC)
8. I _____________________________________________________________ agree and certify that all representation / information made in my attached (Name of Staff member) updated resume best describes myself, qualifications and experience to the best of my knowledge. I have provided said Supplier of Works Applicant with my particulars which include(s): (Please tick) Update Resume Academic Qualification(s) Certificate(s) License(s) 9
Signature _________________________________ Signature ___________________________________________ (Staff member’s Signature) (Director’s / Authorized representative’s Signature) Date _________________________________ Date ____________________________________________ (dd / mm / yyyy) (dd / mm / yyyy) PUBLIC PROCUREMENT COMMISSION – Approved Supplier of Works Grades 1 – 4 Application Form - 03/2019 SECTION 1 Page 10 of 20 G. STAFFING10. Supervisory (This page may be copied as required to provide information for additional staff members)Supervisory Staff includes: Individuals with appropriate experience in the construction industry with responsibility for on-site day-to-day activities
At the time of Application, individuals who have a formal working relationship with the Supplier of Works and/or Applicant in a capacity such as Consultants, Full- time or Part-time staff. Individuals may also be professionally and technically trained
Name of Individual: No. Years with Applicant:Number of years in construction industry:a) Name of Professional Registration Board: Year of last registration:b) Name of Professional AssociationEducational Level Achieved (eg: High / Tech Sch., Cert., Dip., Bsc., Ma., Msc.) Year Qualified Accrediting Institution / / / /General Instructions: i) Complete the table below regarding experience in EACH category of work for which registration is being applied for
ii) Attach detailed and updated resume to the Application Form for EACH Professional Staff member submitted. ** iii) Attach Academic Qualification(s) and / or Professional Association Certificate(s) / Licence(s). ** Category Applied for No. of Years Experience in this (List name of category) Category of Work Position Held Project Description** Refer to Section III of the Application Form for the Detailed Requirements for Registration
PUBLIC PROCUREMENT COMMISSION – Approved Supplier of Works Grades 1 – 4 Application Form - 03/2019 SECTION 1 Page 11 of 20 G. STAFFING 11. Supervisory Staff Certification and Authorization FormInstructions: a) Complete one (1) Staff Certification and Authorization Form for EACH Supervisory staff being submitted
b) Attach an UPDATED resume for EACH Supervisory staff being submitted in the Supplier of Works Application Form c) Submit the original along with a photocopy OR a copy certified, signed, sealed and dated by a Justice of the Peace / Notary Public of Academic Qualification(s) AND/OR Certificate(s) AND/OR License(s). (Unless previously submitted, verified and valid) d) Submit the original along with a photocopy of a picture identification with signature OR a copy certified, signed, sealed and dated by a Justice of the Peace / Notary Public for EACH Supervisory staff being submitted in the Supplier of Works Application Form. (Example Driver’s License, Employee ID, National ID, Passport etc)12. I _______________________________________________________________hereby solemnly declare that I am currently (Name of Staff member) employed to _________________________________________________________ My current employment status with the Applicant as at (Name of Supplier of Works Applicant seeking registration with PPC) ____________________________ is in a Please tick)Full Time Part Time Contractual Date (dd/mm/yyyy) Other __________________ (please specify) capacity for registration with the Public Procurement Commission (PPC)
13. I ______________________________________ ___________________agree and certify that all representation / information made in my attached (Name of Staff member) updated resume best describes myself, qualifications and experience to the best of my knowledge. I have provided said Supplier of Works Applicant with my particulars which include(s): (Please tick) Update Resume Academic Qualification(s) Certificate(s) License(s) 14
Signature _________________________________ Signature ___________________________________________ (Staff member’s Signature) (Director’s / Authorized representative’s Signature)Date _________________________________ Date ____________________________________________ (dd / mm / yyyy) (dd / mm / yyyy) PUBLIC PROCUREMENT COMMISSION – Approved Supplier of Works Grades 1 – 4 Application Form - 03/2019 SECTION 1 Page 12 of 20
PUBLIC PROCUREMENT COMMISSION – Approved Supplier of Works Grades 1 – 4 Application Form - 03/2019 SECTION 1 Page 11 of 20 G. STAFFING 10. Supervisory (This page may be …
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