CNA Registration Form - KNACB Portal

Personal Information

Full Name

Date of Birth

Marital Status

Gender

Male
Female
Other

ID Number

Contact Details

Phone Number (Primary)

Email Address

Postal Address

Physical Address (City, County/Region)

Educational Background

High School Name

Year of Completion

Relevant Certifications

Institution Attended

Level of Training Completed

Certificate
Diploma
Other

Professional Details

Nursing Council Registration Number (if applicable)

Current Employer (if applicable)

Years of Experience

Emergency Contact Details

Name of Emergency Contact

Relationship

Emergency Contact Phone Number

Required Document Uploads

Upload Your Copy of National ID/Passport ( Files accepted: .pdf. jpg, png - Max file size: 10mb )

Select document

Upload Your Academic Certificates ( Files accepted: .pdf. .jpg, .png, .doc, .docx - Max file size: 10mb )

Select documents

Upload Training Certificates ( Files accepted: .pdf. .jpg, .png, .doc, .docx - Max file size: 10mb )

Select documents

Upload Good Conduct/Police Clearance Certificate ( Files accepted: .pdf. jpg, png - Max file size: 10mb )

Select document

Upload Passport-Sized Photo ( Files accepted: .pdf. jpg, png - Max file size: 10mb )

Select document

Mpesa Payment Details

Mpesa Paybill/Till Number: [Enter Paybill/Till Number]

Payment Instructions

1. Go to Mpesa Menu on your phone.
2. Select Lipa na Mpesa.
3. Choose Paybill or Buy Goods.
4. Enter the Paybill/Till Number provided.
5. Enter your National ID/Passport Number as the account/reference.
6. Enter the amount and confirm the payment.
7. Save the transaction SMS for reference.

Mpesa Transaction Code

Phone Number Used for Payment

Payment Amount

Date of Payment

Declaration and Consent

Password

Confirm Password

I declare that the information provided is accurate and truthful to the best of my knowledge.

I consent to the collection and processing of my personal data as per the data protection policy.