INSTRUCTIONS

UNITED NATIONS DEVELOPMENT

Please answer each question clearly

1. Family Name
2. Date
of Birth

First Name

Da

7. Height

Mo

Yr

8. Weight

Middle name

3. Place of Birth

Maiden name, if any

4. Nationality (ies) at birth

5. Present nationality (ies)

6. Sexe

9. Marital status
Single

10. Permanent address

Married
11. Present Address (if different)

Telephone No.
Fax No.

Separated

Widow
12. Office Telephone No.
Office Fax No.
Office E-mail No.

Divorced

Telephone No.
Fax No.

13. Do you have a spouse and/or children? YES

NAME

NO

Date of birth

if the answer is "yes", give the following information:

Relationship

NAME

14. Have you taken up any legal permanent status in any country other than that of your nationality?
If the answer is "yes", which country?

YES

15. Have you taken any legal steps towards changing your present nationality?
If answer is "yes", explain fully:

Date of birth

YES

NO

NO

16. Are any of your relatives employed by UNDP, any other UN organization or any other public international organization?
If the answer is "yes", give the following information:
NAME

Relationship

Relationship

YES

NO

Name of International Organization

17. What is your preferred field of work?

Easily

WRITE

Not Easily

Easily

Not Easily

19. For clerical grades only

SPEAK
Fluently

Not Fluently

UNDERSTAND
Easily

Not Easily

List any office machines or equipment you can use

Other languages

PAGE 2
20. EDUCATIONAL. Give full details - N.B. Please give exact titles or degree in original language.
A. UNIVERSITY OR EQUIVALENT
Please do not translate or equate to other degrees.
NAME, PLACE AND COUNTRY

ATTENDED FROM/TO
Mo./Year

Mo./Year

DEGREES and ACADEMIC

MAIN COURSE

DISTINCTIONS OBTAINED

OF STUDY

B. SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION FROM AGE 14 (e.g. high school, technical school or apprenticeship)
NAME, PLACE AND COUNTRY

TYPE

ATTENDED FROM/TO
Mo./Year

Mo./Year

CERTIFICATES OR
DIPLOMAS OBTAINED

21. LIST PROFESSIONAL SOCIETIES AND ACTIVITIES IN CIVIC, PUBLIC OR INTERNATIONAL AFFAIRS

22. LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN (Do not attach)

23. EMPLOYMENT RECORD: Starting with your present function, list in reverse order every employment you have had. Use a separate block for each
FUNCTION. Include also service in the armed forces and note any period during which you were not gainfully employed. If you need more space, attach
additional pages of the same size. Give both gross and net salaries per annum for your last and present FUNCTION.
A. PRESENT FUNCTION (LAST FUNCTION, IF NOT PRESENTLY IN EMPLOYMENT)
FROM

TO

MONTH/YEAR

MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

FINAL

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:

NO AND KIND OF EMPLOYEES

DESCRIPTION OF YOUR DUTIES

REASON FOR LEAVING:

B.

PREVIOUS FUNCTION (IN REVERSE ORDER)

PAGE 3
EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:

REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES

FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:

REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES

FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:

REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES

FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES

REASON FOR LEAVING:

PAGE 4
FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:

REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES

FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:

REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES

FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:

REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES

FROM
MONTH/YEAR

TO
MONTH/YEAR

SALARY PER ANNUM

EXACT TITLE OF YOUR FUNCTION:

NAME OF EMPLOYER:

TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:

NAME OF SUPERVISOR:
NO AND KIND OF EMPLOYEES
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES

REASON FOR LEAVING:

PAGE 5
24. DO YOU HAVE ANY OBJECTIONS TO OUR MAKING ENQUIRIES OF YOUR PRESENT EMPLOYER?

YES

NO

25. ARE YOU NOW, OR HAVE YOU EVER BEEN A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENTS EMPLOY? YES
If answer if "yes", WHEN?

NO

26. REFERENCES: List three persons, not related to you, who are familiar with your character and qualifications.
Do not repeat names of supervisors listed in item 24.
FULL NAME

FULL ADDRESS

BUSINESS OR OCCUPATION

27. STATE ANY OTHER RELEVANT FACTS IN SUPPORT OF YOUR APPLICATION. INCLUDE INFORMATION REGARDING ANY RESIDENCE
OUTSIDE THE COUNTRY OF YOUR NATIONALITY.

28. HAVE YOU BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR
CONVICTED, FINED OR IMPRISONED FOR THE VIOLATION OF ANY LAW (excluding minor traffic violations)?
YES NO
If "yes", give full particulars of each case in an attached statement.
29. I certify that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief. I
understand that any misrepresentation or material omission made on a Personal History form or other document requested by the Organization may result
in the termination of the service contract or special services agreement without notice.

DATE:

SIGNATURE:

NB. You will be requested to supply documentary evidence which support the statements you have made above. Do not, however, send any documentary
evidence until you have been asked to do so and, in any event, do not submit the original texts of references or testimonials unless they have been
obtained for the sole use of UNDP.