Chartered Bills: House of Reps HB 667 and Senate SB 1015
Get trained. Get certified. Get connected
ESMI Programs/Courses
1. Basic Certificate in Safety (BCS/JESP)- $35.00
2. HSE 1,2 & 3 (Diploma/AESM) - $75.00
3. Advanced Diploma in Safety Management (Advance Diploma/CESM) - $97.00
4. Professional certificate in Food Safety -(Food Safety) $87.00
5. Professional certificate in Water Safety Management (Water Safety) $87.00
6. Professional Diploma in Environmental Impact Assessment - (EIA) $75.00
7. Professional Diploma In Disaster and Emergency Management - (Disaster Management) $87.00
8. Professional Diploma in Fire Prevent, Control and Management - (Fire Safety) $87.00
9. Safety and Security Management -(SSM) $75.00
10. Quality Control in Occupational Health and Safety - *(QCMHS) $75.00
11. Office Safety and Good House Keeping - $65.00
12. Infection Prevention and Control - $75.00
13. Dispute Resolution and Conflict Management - $65.00
14. First Aid Management - $75.00
15. Facility Safety and Management - $87.00
16. Monitoring and Evaluation of Health Programmes and services $87.00
17. Project Management, Monitoring and Evaluation $87
18. Advanced Diploma in Industrial Hygiene and Occupational Health - $97
Call or WhatsApp 08179716797
Visit www.esmi.org.ng to register
COURSE APPLICATION FORM
Please complete this form in full. If additional space is required, attach a separate sheet, indicating the section
number that it refers to. Return original copy form and photocopies of the credentials in hard copy to:
Environment and Safety Management Institute
36 Jos road Lafia, Nasarawa State, NIGERIA
TEL: (+234) 8179716797
E-MAIL: info@esmi.org.ng
If you send your application by e-mail, please send the hard copy as well. Your application
should reach ESMI by the deadline given in the course announcement. Forms that are not
received in hard copy or that are incomplete will not be activated to sit for the professional
examination.
1. CANDIDATE
MUHAMMAD MUS’AB MAZADU MALE
(SURNAME) FIRST SINGLE NAME(S) SEX
17TH MARCH 1994 NIGERIA
DATE OF BIRTH: DAY MONTH YEAR NATIONALITY MARITAL STATUS
FEDERAL POLYTECHNIC NASARAWA
INSTITUTION/BUSINESS NAME AND ADDRESS (you must provide this information)
CITY COUNTRY POSTAL CODE
08067277800 MAZADUMUS’AB8@GMAIL.COM
TELEPHONE E-MAIL
MAILING ADDRESS (if different from above) 2.
TRAINING ACTIVITY
Indicate the course for which you are applying
COURSE TITLE YEAR VENUE
3. EDUCATIONAL BACKGROUND
A. ACADEMIC QUALIFICATIONS
FULL NAME OF INSTITUTION AND DURATION DEGREE OBTAINED
COUNTRY (FROM – TO) (Title and subject)
B. RELEVANT PROFESSIONAL COURSES (Including ESMI courses)
4. PROFESSIONAL ACTIVITIES
PRESENT OCCUPATION FROM (DATE)
INSTITUTION, ORGANIZATION OR COMPANY
ADDRESS TELEPHONE (+ area code) FAX (+ area code) E-MAIL
RELEVANT PREVIOUS ACTIVITIES FROM -TO (DATES) RESPONSIBILITIES
5. PERSONAL STATEMENT
Explain why you are applying for this course, what you hope to learn from it, and how it will benefit
your professional development and your institution
6. OFFICIAL ENDORSEMENT
Your application will not be considered unless this section is correctly filled in by the person endorsing the
application (public official, employer, or academic supervisor). The undersigned:
NAME TITLE OR POSITION INSTITUTION OR ORGANIZATION
ADDRESS TELEPHONE E-MAIL
endorses the application of the candidate: [NAME………………………………………………………………….]
Will the candidate's present position still be available to him/her after the course is over? YES ....... NO ......
SIGNATURE OF PERSON ENDORSING APPLICATION DATE & STAMP OF INSTITUTION
7. CANDIDATE'S STATEMENT
I declare that the above information is true and correct. I also declare that, to the best of my knowledge,
my health allows me to undertake the proposed study programme. I also take note that if my application
is accepted I shall have to undergo a medical examination at my own expense, according to instructions
received from ESMI, and that my participation in the course will be conditional upon the satisfactory
results of this examination
CANDIDATE'S SIGNATURE DATE
