ࡱ> _ V(bjbj ;bbH  8F,rT&j%%%%%%%':*4%%%###6%#%##:$,$ʟ= R$ %%0&$ n+!tn+$n+$#%%#X&n+ : 4INSTRUCTIONS Please answer each question clearly and completely. Type or print in ink. Read carefully and follow all directions.UNITED NATIONS DEVELOPMENT PROGRAMME PERSONAL HISTORY FORM (for Service Contracts and Individual Contracts)1. Family Name First Name Middle name Maiden name, if any 2. Date of BirthDa Mo Yr 3. Place of Birth 4. Nationality (ies) at birth 5. Present nationality (ies) 6. Sexe 7. Height 8. Weight 9. Marital status Single SYMBOL 111 \f "Wingdings" Married SYMBOL 111 \f "Wingdings" Separated SYMBOL 111 \f "Wingdings" Widow SYMBOL 111 \f "Wingdings" Divorced SYMBOL 111 \f "Wingdings"10. Permanent address Telephone No. Fax No. 11. Present Address (if different) Telephone No. Fax No. 12. Office Telephone No. Office Fax No. Office E-mail No. 13. Do you have a spouse and/or children? YES SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" if the answer is "yes", give the following information:NAMEDate of birthRelationshipNAMEDate of birthRelationship14. Have you taken up any legal permanent status in any country other than that of your nationality? YES SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" If the answer is "yes", which country? 15. Have you taken any legal steps towards changing your present nationality? YES SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" If answer is "yes", explain fully: 16. Are any of your relatives employed by a public international organization? YES SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" If the answer is "yes", give the following information:NAMERelationshipName of International Organization17. What is your preferred field of work? 18. KNOWLEDGE OF LANGUAGES. What is your mother tongue? READWRITESPEAKUNDERSTANDOTHER LANGUAGESEasilyNot EasilyEasilyNot EasilyFluentlyNot FluentlyEasilyNot Easily19. For clerical grades only Indicate speed in words per minuteList any office machines or equipment you can useEnglishFrenchOther languagesTypingShorthand 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 COUNTRYATTENDED FROM/TODEGREES and ACADEMICMAIN COURSEMo./YearMo./YearDISTINCTIONS OBTAINEDOF STUDYB. SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION FROM AGE 14 (e.g. high school, technical school or apprenticeship)NAME, PLACE AND COUNTRYTYPEATTENDED FROM/TOCERTIFICATES ORMo./YearMo./YearDIPLOMAS OBTAINED21. 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)FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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  B. PREVIOUS FUNCTION (IN REVERSE ORDER) PAGE 3 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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  PAGE 4 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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 FROMTOSALARY PER ANNUMEXACT TITLE OF YOUR FUNCTION:MONTH/YEARMONTH/YEARSTARTINGFINALNAME 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  PAGE 5 24. DO YOU HAVE ANY OBJECTIONS TO OUR MAKING ENQUIRIES OF YOUR PRESENT EMPLOYER? YES SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" 25. ARE YOU NOW, OR HAVE YOU EVER BEEN A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENTS EMPLOY? YES SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" If answer if "yes", WHEN? 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 NAMEFULL ADDRESSBUSINESS OR OCCUPATION27. 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 SYMBOL 111 \f "Wingdings" NO SYMBOL 111 \f "Wingdings" 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.        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