UNITED NATIONS DEVELOPMENT PROGRAMME

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 UNDP? 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 UNDP? 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 UNDP 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. UNDP 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:
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

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 UNDP 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 UNDP.

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 UNDP.

24. EDUCATIONAL. Give full details - N.B. Please give exact titles of degrees in original language.

A. UNIVERSITY OR EQUIVALENT Please do not translate or equate to other degrees.

NAME, PLACE AND COUNTRY	ATTENDED FROM/TO	DEGREES and ACADEMIC

MAIN COURSE OF STUDY
Mo./Year	Mo./Year	DISTINCTIONS OBTAINED
B. SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION FROM AGE 14 (e.g. high school, technical school or apprenticeship)

NAME, PLACE AND COUNTRY

TYPE	ATTEND FROM/TO	CERTIFICATES OR
Mo./Year	Mo./Year	DIPLOMAS OBTAINED
25. LIST PROFESSIONAL SOCIETIES AND ACTIVITIES IN CIVIC, PUBLIC OR INTERNATIONAL AFFAIRS

26. LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN (do not attach)

27.	EMPLOYMENT RECORD: Starting with your present post, list in reverse order every employment you have had. Use a separate block for each post. 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 or present post.

A. PRESENT POST (LAST POST, IF NOT PRESENTLY IN EMPLOYMENT)
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:
MONTH/YEAR	MONTH/YEAR	STARTING	FINAL

NAME OF EMPLOYER:	TYPE OF BUSINESS:
ADDRESS OF EMPLOYER:	NAME OF SUPERVISOR:
NO. AND KIND OF EMPLOYEES	REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES

B. PREVIOUS POSTS (IN REVERSE ORDER)
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR	MONTH/YEAR	STARTING	FINAL

NAME OF EMPLOYER:	TYPE OF BUSINESS:
ADDRESS OF EMPLOYER:	NAME OF SUPERVISOR:
NO. AND KIND OF EMPLOYEES	REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR	MONTH/YEAR	STARTING	FINAL

NAME OF EMPLOYER:	TYPE OF BUSINESS:
ADDRESS OF EMPLOYER:	NAME OF SUPERVISOR:
NO. AND KIND OF EMPLOYEES	REASON FOR LEAVING
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR	MONTH/YEAR	STARTING	FINAL

NAME OF EMPLOYER:	TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:	NAME OF SUPERVISOR:
NO. AND KIND OF EMPLOYEES	REASON FOR LEAVING
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES

FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR	MONTH/YEAR	STARTING	FINAL

NAME OF EMPLOYER:	TYPE OF BUSINESS:

ADDRESS OF EMPLOYER:	NAME OF SUPERVISOR:
NO. AND KIND OF EMPLOYEES	REASON FOR LEAVING
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES

28. HAVE YOU ANY OBJECTIONS TO OUR MAKING INQUIRIES OF YOUR PRESENT EMPLOYER? YES NO

29. ARE YOU NOW, OR HAVE TO EVER BEEN, A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENT’S EMPLOY? YES NO
If answer is “yes”, WHEN?

30. REFERENCES: List three persons, not related to you, who are familiar with your character and qualifications.

Do not repeat names of supervisors listed under item 27.

FULL NAME	FULL ADDRESS	BUSINESS OR OCCUPATION
31. STATE ANY OTHER RELEVANT FACTS, INCLUDING INFORMATION REGARDING ANY RESIDENCE OUTSIDE THE COUNTRY OF YOUR NATIONALITY

32..

HAVE YOUR EVER 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.

33.	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 renders a staff member of the United Nations liable to termination or dismissal.

DATE:
SIGNATURE :
N.B.	You will be requested to supply documentary evidence which supports the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so by the Organization and, in any event, do not submit the original texts of references or testimonials unless they have been obtained for the sole use of the Organization.

un - curriculum vitae

moussa

cv

JAKARTA

2008-03-07

ddarwish

UNFPA