Personal History Form

United Nations Development Programme   Personal History Form 1 United Nations Plaza, New York, NY  10017

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.  Please attach recent passport-size photograph.

1. Family name (Surname)

First names

Maiden name, if applicable

2. Date of Birth day               month           year

3. Place of birth

4. Nationality at birth

5. Present nationality(ies)

6. Sex Male   Female

7. Height

8. Weight

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?   YES      NO    If "yes" please describe:

11. Permanent address

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

13.  Office Telephone no.

Telephone No.

Telephone No.

Telephone No. (messages)

14.     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

15. Have you taken up legal permanent residence status in any country other than that of your nationality?   Yes   No   if “Yes”, which country?

16. Have you taken any steps towards changing your present nationality?  Yes   No   if “Yes”, explain fully:

17.  Are any of your relatives employed by a public international organization? Yes   No  if  answer is "yes”, give the following information:

Name

Relationship

Name of International Organization

18. What is your preferred field of work?

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

20. Have you previously submitted an application for employment with U.N.? If so when?

21. Languages - List mother tongue first

Ability to read

Ability to write

Ability to speak

Very good

Good

Weak

Very good

Good

Weak

Very good

Good

Weak

22. Clerical skills (for clerical employment only).

List any office machines or equipment you can use below:

Indicate speed in words per minute

English

French

Spanish

Other languages

Typing

Shorthand

23. EDUCATION: Give full details  - NB Please give exact titles of degrees in original language A.  University or equivalent (most recent first) of the educational institutions you have attended and other specialized courses.  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. 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

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

25. List any significant publications you have written (do not attach them).

26. 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.  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 (gross)

Final (gross)

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

B.     PREVIOUS POSTS (IN REVERSE ORDER - I.E. MOST RECENT POSTS FIRST)
FROM	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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	TO	SALARIES PER ANNUM		EXACT TITLE OF YOUR POST:
Month/Year	Month/Year	Starting (gross)	Final (gross)
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

27. Have you any objections to our making inquiries of: (a) your present employer? Yes        No    ; (b) previous employers?      Yes                 No
28. ARE YOU NOW, OR HAVE YOU EVER BEEN, A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENT'S EMPLOY?  Yes              No     If answer is "yes", WHEN?
29. References: list three persons not related to you who are familiar with your character and qualifications and who may be contacted for a reference      DO NOT REPEAT NAMES OF SUPERVISORS LISTED UNDER ITEM 26.
FULL NAME	FULL ADDRESS	BUSINESS OR OCCUPATION
30. STATE ANY OTHER RELEVANT FACTS IN SUPPORT OF YOUR APPLICATION.  INCLUDE INFORMATION REGARDING ANY RESIDENCE OUTSIDE THE COUNTRY OF YOUR NATIONALITY
31. HAVE YOU 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
32. 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 UNDP Personal History form or other document requested by the Organization renders a staff member of the United Nations Development Programme liable to termination or dismissal. 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.