ODM Governor Application Form

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					                        APPLICATION FORM


                                  FOR


                              NOMINATION OF

                               GOVERNOR




Orange House, Menelik Road,
Kilimani Area,
P.O Box 2478 – 00202
Nairobi
Tel: 020 2053481
Fax: 020 2177703



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(To Be Completed in Duplicate)

SECRETARY
THE NATIONAL ELECTIONS BOARD
ORANGE DEMOCRATIC MOVEMENT
P.O BOX 2478 – 00202
NAIROBI

                                           PART A

I, …………………………………………………………………………….. do hereby apply to
contest as Governor in the ODM Party primaries in ……………………… County.

      1.    Party Membership No ………………………………………………………………
      2.    Electors Card No ……………………………………………………………………
      3.    National Identity Card No ………………………………………………………….
      4.    Physical Address…. …………………………………………………………………
      5.    Postal Address……………….. …………………………….………………………..
      6.    Telephone……………..………………………………………………………………
      7.    Email Address………………………………………………………………………..
      8.    Sub location……. ………………………...………………………………………….
      9.    Ward...………………………………………………………………………………..
      10.   Constituency…….. …………………………………………………………………..
      11.   County…...……………………………………………………………………………

                   PART B: PARTICIPATION IN PARTY PROGRAMS

  1. When did you become a member of ODM? …………………………………………………

  2. Provide evidence of your participation in the management of party programs in National/
     Branch/Sub Branch/Ward level
     …………………………………………………………………………………………………
     …………………………………………………………………………………………………
     …………………………………………………………………………………………………
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     …………………………………………………………………………………………………

  3. Are you a member of any organ of the party? ……………………………………………….
     …………………………………………………………………………………………….....

  4. Demonstrate your ability to articulate any two objectives of the party manifesto …...
     …………………………………………………………………………………………………
     …………………………………………………………………………………………………
     …………………………………………………………………………………………………
     …………………………………………………………………………………………………
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  5. Briefly state your commitment and passion to the party, its ideology, policies and programs.
     ………………………………………………..........................................................................
     ………………………………………………………………………………………………..…
     ……………………………………………………………………………………………..……
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   …………………………………………………………………………………………...............
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6. Can you be described as a disciplined and dependable party member? Please illustrate in not
   more than two hundred and twenty words.
   …………………………………………………………………………………………………
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PART C:

1. Briefly state the role you have played in the realization of the new constitution of the Republic
   of Kenya.
   …………………………………………………………………………………………………
   …………………………………………………………………………………………………
   …………………………………………………………………………………………………
   …………………………………………………………………………………………………
   …………………………………………………………………………………………………

2. Provide evidence of your performance in the politics of Kenya as measured against any two of
   the following key achievements:

             Members of Parliament
             Minister or Assistant Minister?
             Chair or a member of a Parliamentary Committee
             Served in any capacity in the National Assembly
             Served in a responsible position in the public service or Private Sector
             Any other achievement? (specify) …………………………………………………….
              …………………………………………………………………………………………
              ………………………………………………………………………………………….

3. Would you describe yourself as:
              a) An inspirational, transformative and servant leader?
              b) A team player

4. Provide evidence of your:
               i. Commitment in promoting democracy and human rights?
              ii. Commitment to national patriotism reconciliation and cohesion
             iii. Commitment to affirmative action.

5. Demonstrate your ability to mount a successful campaign (in not more than 500 words).
   …………………………………………………………………………………………………
   …………………………………………………………………………………………………
   …………………………………………………………………………………………………

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      …………………………………………………………………………………………………
      …………………………………………………………………………………………………

PART D: LEADERSHIP AND INTEGRITY


   1) Have you at any time within five years immediately preceding the date of the General
      Elections,   held    office      as     a    member       of     a      Commission?
      ……………………………………………………...

   2) Have you ever been declared bankrupt? …………………………………………………….

   3) Have you ever been convicted in a court of law on a criminal offence/abuse of office or in any
      other way contravened Chapter Six of the Constitution of Kenya?


PART E
  Please submit your application with the following
     1) A Non-refundable nomination fee of Kenya Shillings Three Hundred Thousand (Ksh. 300,
         000) payable by Bankers Cheque to Orange Democratic Movement or deposit in the
         Party’s Account.

      2) A detailed Curriculum Vitae indicating amongst other qualifications the following: -
            a) Education qualifications.
            b) Experience in the management of public affairs.

      3) A copy of your educational qualifications

      4) A copy of your National Identification Card

      5) A copy of your Elector’s Card

      6) A copy of your Orange Democratic Movement Life Membership Certificate

      7) Duly executed Code of Conduct;


   Dated At………………………This………………………Day of ……………………..2012

                        …………………………………………………………………
                                 SIGNATURE


   NB: Please submit your application with a copy of the receipt for the application fees duly paid.
   ………………………………………………………………………………………………………………..

   For Official Use only

   Receipt No.: ………………………………………Date………………………


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Approved By NEB ………………………………………………….. Date ……………………..

                       ORANGE DEMOCRATIC MOVEMENT

                                       CODE OF CONDUCT

 I _______________________________________________ being an aspiring candidate for
________________________________ Ward/Constituency/County do hereby subscribe to the
Orange Democratic Movement Code of Conduct and solemnly declare as follows; that I—

1. Shall respect, uphold and defend the Party Constitution, Party Election and Nomination Rules,
Manifesto and any other Party rules and regulations.

2. Shall observe this Code of Conduct pursuant to Articles 91, 92 of the Constitution of the
Republic of Kenya, section 8 of the Political Parties Act and any other Electoral Laws

3. Shall respect all Party Organs, the Party Leadership, preserve and protect the good image of
the Party;
4. Shall uphold and promote good Governance, Patriotism, National Reconciliation, Integrity,
Cohesion, Respect, Tolerance, Transparency, Accountability; Rule of Law and National Unity;
5. Shall respect and promote human rights, fundamental freedoms, human dignity, equity, social
justice, inclusiveness and non-discrimination and protection of the marginalized;

6. Shall respect and uphold the democratic rights of other members in competition for political
power;

7. Shall promote consensus building in decision making on issues of national importance that
affect the Party;

8. Shall respect and promote gender equity and the right of all persons to participate in the
political process including the Youth, Minorities and the Marginalized groups;

9. Shall Respect, uphold and promote democratic values, the principles of free, fair and credible
elections within the Party organs and the principles of leadership and integrity as enshrined in the
Constitution of the Republic of Kenya.

10. I further aver that I shall not—

a. engage in or encourage violence intimidation of/ or by Party members, opponents, supporters
or any other person or other Political Parties;
b. engage in /or influence peddling, bribery or any other form of corruption and accept or use
illicit or illegal money;
c. Advocate hatred that constitutes ethnic incitement, vilification of others or incitement to
cause harm;
d. Obstruct, disrupt, break-up or in any other way whatsoever interfere with any political
meeting, rally or demonstration of another political party or its leadership
e. establish or maintain a Para-Military force, militia or similar organization or have any links
with such organizations;
f. use state resources for partisan campaigns;


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g. carry or allow weapons and /or machetes to be carried at political meetings and polling
centers;
h. publish or report false, defamatory or inflammatory allegations about political opponents.
i. Prevent eligible voters from having access to political opponents;
j. Discriminate on the basis of race, sex, ethnicity, social class or religion;

I hereby pledge:-
1) My loyalty and commitment to my Party and its leadership
2) Adhere to Party policy and programs for the entire duration that I shall be a member of the
Party.
4) To contribute to the Party such monthly contributions as may be set upon after my election as
Member of the Senate/ Governor/ Member of the National Assembly/ County Woman
Representative/ Member of the County Assembly. (Tick as appropriate)
5) Take all reasonable steps to protect members of the National Elections Board and other
election officers in their course of duty.
6) Take necessary and reasonable steps to instill discipline of my agents and supporters.
Any member who evidently defaults on the above shall be subject to:-
1. Disciplinary action by the Party.
2. Denial by Orange Democratic Movement of its ticket for candidature.
3. Denial of Orange Democratic movement elective position.

This declaration is made to the best of our knowledge, information and belief.

DATED THIS ……………………………DAY OF……………..2012

Signed by:
Name of Candidate …………….……………………………………………….
Signature ………………………………………………………………………….

In the presence of


COMMISSIONER FOR OATHS/MAGISTRATE




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