Instructions: Please answer each question clearly and completely. Type or print in ink. Read carefully and follow all directions. If you need more space, attach additional pages of the same size




Дата канвертавання25.04.2016
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Personal History Form



INSTRUCTIONS: Please answer each question clearly and completely. Type or print in ink. Read carefully and follow all directions. If you need more space, attach additional pages of the same size.


1. Family name (surname)

     



2. First names

     


3. Maiden name, if applicable

     


4. Date of Birth

day month year

                 


5. Place of birth
     

6. Nationality at birth

     


7. List all your current nationality(ies)

     


8. Gender
Male  Female 


9. Marital status Single  Married  Separated  Widow(er)  Divorced 

10. Entry into United Nations service might require assignment and travel to any area of the world in which the United Nations might have responsibilities. Have you any disabilities which might limit your prospective field of work or your ability to engage in air travel?
No  Yes  If "yes" please describe:      

11. Permanent address

     



12. Present address if different from that indicated in box 11.

     




13. Office Telephone number

Home/Mobile;      

Work;      



Telephone No.      

Telephone No.      

14. Personal and/or professional e-mail address:      

15. Have you any dependents? Yes  No  if the answer is “Yes”, give the following information:

Name


Date of birth


Relationship


Name

Date of birth

Relationship



     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

16. Have you taken up legal permanent residence status in any country other than that of your nationality?

No  Yes 

if “Yes”, which country(ies)?      


17. Have you taken any steps towards changing your present nationality?

No  Yes 

if “Yes”, explain fully:      


18. Are any of your family members (spouse/partner, father,/mother, brother/sister, son/daughter) employed in the UN common system, including UN Women? Yes  No  if answer is "yes”, give the following information:

Name

Relationship

Name of Organization

     

     

     

     

     

     

     

     

     

19. Do you have any other (extended) family members in UN Women? No  Yes  if answer is "yes”, give the following information:

Name

Relationship

     

     

     

     

20. Would you accept employment for less than six months? Yes  No 


21. Have you been interviewed for any UN Women positions in the last 12 months? If so, for which post(s)?      

22. Languages - mother tongue 1st

Ability to operate in the listed language(s) in a work environment




Read

Write

Speak

Understand

     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



     

 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



 none

 limited

 working knowledge

 proficient



23. For support General Service level posts only, indicate if you passed the following tests:
ASAT – Administrative Support Assessment Test (formerly known as clerical test): No Yes  if “Yes”, date taken      
UN Accounting Assistant Exam : No  Yes  No Yes  if “Yes”, date taken      



24. EDUCATION: Give full details - NB Please give exact titles of degrees in original language
A. List all institutions of learning attended since age 14 and diplomas/degrees or equivalent qualifications obtained (highest education first). Give the exact name of institution and title of degrees, diplomas, etc. (Please do not translate or equate to other degrees.)



Name, place and country

Attended From/To

Mo/Year Mo. /Year

Certificates, diplomas or degrees and academic distinctions obtained

Main course of study

     


     

     

     

     

     


     

     

     

     

     


     

     

     

     

     


     

     

     

     

     


     

     

     

     

     


     

     

     

     

     


     

     

     

     

B. Post-qualification training courses / learning activities



Name, place and country


Type

Attended From/To

Mo/Year Mo. /Year

Certificates or

Diplomas obtained

     


     

     

     

     

     


     

     

     

     

     


     

     

     

     

C. UN Language Proficiency Exams (if any)



     


     

     

     

     

D. UN Certification Programmes (if any)



     


     

     

     

     


25. List membership of professional societies and activities in civic, public or international affairs


     


     


     


     


26. List any significant publications you have written (do not attach them) or any special recognition


     


     


     



27. EMPLOYMENT RECORD: Starting with your present post, list in reverse order every employment you have had. Use a separate block for each employment. 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. Provide gross and indicate denomination salary per annum for your last or present post.
Have you already been issued a UN Index Number? No  Yes  If yes, please indicate this number:      

Are you a current or former UNV? Yes  No  If yes, please indicate roster number:      



  1. PRESENT POST (LAST POST, IF NOT PRESENTLY IN EMPLOYMENT)

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     


Starting (gross)

     


Final (gross)

     


NAME OF EMPLOYER:

     


TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other      

ADDRESS OF EMPLOYER

     



NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. Of Supervisor:     




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     

DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     



  1. PREVIOUS POSTS (IN REVERSE ORDER - I.E. MOST RECENT POSTS FIRST)

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     





Final (gross)

     


NAME OF EMPLOYER

     




TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other      

ADDRESS OF EMPLOYER

     


NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:      




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     

DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     





Final (gross)

     


NAME OF EMPLOYER

     



TYPE OF BUSINESS:      


EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other      

ADDRESS OF EMPLOYER

     




NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:      




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     

DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     





Final (gross)

     


NAME OF EMPLOYER

     


TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other      

ADDRESS OF EMPLOYER

     



NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:      




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     

DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     





Final (gross)

     


NAME OF EMPLOYER

     




TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other      

ADDRESS OF EMPLOYER

     


NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:      




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     

DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     





Final (gross)

     


NAME OF EMPLOYER

     



TYPE OF BUSINESS:      


EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other     

ADDRESS OF EMPLOYER

     




NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:     




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     


DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     





Final (gross)

     


NAME OF EMPLOYER

     


TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other      

ADDRESS OF EMPLOYER

     



NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:     




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     


DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     


Starting (gross)

     


Final (gross)

     


NAME OF EMPLOYER

     




TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other     

ADDRESS OF EMPLOYER

     


NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:     




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     


DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     


Starting (gross)

     


Final (gross)

     


NAME OF EMPLOYER

     



TYPE OF BUSINESS:      


EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other     

ADDRESS OF EMPLOYER

     




NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:     




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:

     



DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

FROM

TO

SALARIES PER ANNUM

FUNCTIONAL TITLE: As specified in your Letter of Appointment/Contract:      

UN Grade of your post (if applicable):      

Last UN step in your post (if applicable):      


Month/Year

     


Month/Year

     


Starting (gross)

     


Final (gross)

     


NAME OF EMPLOYER



TYPE OF BUSINESS:      

EMPLOYMENT TYPE:

Full time: 

Part Time:  (     %)


Type of contract:
 100 Series

 Permanent

 FTA

 SC


 200 series

 Indefinite

 TA


 UNV

 ALD/300 series

 Continuing

 SSA


 Other     

ADDRESS OF EMPLOYER

     



NAME OF SUPERVISOR:      

Email Add. and/or Telephone No. of Supervisor:     




Number of Professional Staff Supervised:      

Number of Support Staff Supervised:      



Reason for leaving:     


DESCRIPTION OF YOUR DUTIES AND RELATED ACCOMPLISHMENTS

     

28. Have you any objections to our making inquiries of: (a) your present employer? No  Yes  ;

(b) previous employers? No  Yes 




29. Are you now, or have you ever been, a permanent civil servant employee in your government?

No  Yes  If answer is "yes", WHEN?      




30. References: list three persons not related to you who are familiar with your character and qualifications and who may be contacted for a reference


FULL NAME


FULL ADDRESS, including E-MAIL ADDRESS and TELEPHONE NUMBER

BUSINESS OR OCCUPATION


     


     

     

     


     

     

     


     

     

31. State any other relevant facts in support of your application. Include information regarding any residence outside the country of your nationality     

32. Have you ever been convicted, fined, or imprisoned for the violation of any law (excluding minor traffic violations)?

No  Yes  If “Yes” give full particulars of each case in an attached statement

33. Have you ever been imposed disciplinary measures, including dismissal or separation from service, on the grounds of misconduct?

No  Yes  If “Yes” give full particulars of each case in an attached statement

34. Have you ever been separated from service on the ground of unsatisfactory performance?


No  Yes  If “Yes” give full particulars of each case in an attached statement

35. 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 the UN Women Personal History Form may lead to the termination of the appointment or to dismissal. I understand this also applies to any other information or document requested by the Organization for the purpose of my recruitment to and employment with UN Women.


DATE:       SIGNATURE: _________________________________________



Note: You may be requested to provide documentary evidence of 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 originals of any references, testimonials or certificates of academic achievement unless they have been obtained for the sole use of UN Women.








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