Personal History Form

INSTRUCTIONS: Please answer each question clearly and completely Type or print in in! Read care"ully and "ollow all directions I" you need more space# attach additional pa$es o" the same si%e & Family name 'surname( - .ate o" /irth day month year 0 Place o" ,irth ) First names 1 Nationality at ,irth * +aiden name# i" applica,le 2 3ist all your current nationality'ies( 4 5ender Male Female

6 +arital status Single Married Separated Widow(er) Divorced &7 Entry into United Nations service might require assignment and travel to any area o the world in which the United Nations might have responsi!ilities" #ave you any disa!ilities which might limit your prospective ield o wor$ or your a!ility to engage in air travel% No &es ' (yes( please descri!e) && Permanent address &) Present address i di erent rom that indicated in !o* ++" .elephone No" .elephone No" No &* O""ice Telephone num,er #ome,Mo!ile- Wor$-

&0 #ave you any dependents% &es Name Date o !irth

&- Personal and8or pro"essional e9mail address: i the answer is /&es01 give the ollowing in ormation) Name Date o !irth 2elationship

2elationship

&1 #ave you ta$en up legal permanent residence status in any country other than that o your nationality% No &es i /&es01 which country(ies)%

&2 #ave you ta$en any steps towards changing your present nationality% No &es i /&es01 e*plain ully)

&4 3re any o your amily mem!ers (spouse,partner1 ather1,mother1 !rother,sister1 son,daughter) employed in the UN common system1 including UN Women% &es No i answer is (yes01 give the ollowing in ormation) Name Relationship Name o" Or$ani%ation &6 .o you ha:e any other 'e;tended( "amily mem,ers in UN <omen= No &es i answer is (yes01 give the ollowing in ormation) Name Relationship +

45" Would you accept employment or less than si* months% &es No 44" 3an$ua$es 9 mother ton$ue &st

4+" #ave you !een interviewed or any UN Women positions in the last +4 months% ' so1 or which post(s)% 3!ility to operate in the listed language(s) in a wor$ environment Understand none limited wor$ing $nowledge pro icient none limited wor$ing $nowledge pro icient none limited wor$ing $nowledge pro icient none limited wor$ing $nowledge pro icient none limited wor$ing $nowledge pro icient none limited wor$ing $nowledge pro icient none limited wor$ing $nowledge pro icient i /&es01 date ta$en

Read <rite Spea! none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient none none none limited limited limited wor$ing $nowledge wor$ing $nowledge wor$ing $nowledge pro icient pro icient pro icient )*" For support 6eneral Service level posts only1 indicate i you passed the ollowing tests) 3S3. 7 3dministrative Support 3ssessment .est ( ormerly $nown as clerical test)) No UN 3ccounting 3ssistant E*am ) No &es No &es i /&es01 date ta$en &es

)-" >.UC?TION) 6ive ull details 8 N9 :lease give e*act titles o degrees in original language 3" ;ist all institutions o learning attended since age +< and diplomas,degrees or equivalent quali ications o!tained (highest education irst)" 6ive the e*act name o institution and title o degrees1 diplomas1 etc" (:lease do not translate or equate to other degrees") ?ttended From8To Certi"icates# diplomas +ain course o" study Name# place and country +o8@ear +o 8@ear or de$rees and academic distinctions o,tained

9" Post9quali"ication trainin$ courses 8 learnin$ acti:ities Name# place and country Type ?ttended From8To +o8@ear +o 8@ear

Certi"icates or .iplomas o,tained

=" UN 3an$ua$e Pro"iciency >;ams 'i" any( D" UN Certi"ication Pro$rammes 'i" any(

)0 3ist mem,ership o" pro"essional societies and acti:ities in ci:ic# pu,lic or international a""airs )1 3ist any si$ni"icant pu,lications you ha:e written 'do not attach them( or any special reco$nition )2 >+P3O@+>NT R>COR.: Starting with your present post1 list in reverse order every employment you have had" Use a separate !loc$ or each employment" 'nclude also service in the armed orces and note any period during which you were not gain ully employed" ' you need more space1 attach additional pages o the same si>e" :rovide gross and indicate denomination salary per annum or your last or present post" #ave you already !een issued a UN 'nde* Num!er% No &es ' yes1 please indicate this num!er) 3re you a current or ormer UN?% &es No ' yes1 please indicate roster num!er) ? PR>S>NT POST '3?ST POST# IF NOT PR>S>NT3@ IN >+P3O@+>NT( F2@M .@ S3;32'ES :E2 3NNUM FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) Month,&ear Month,&ear Starting (gross) Final UN 6rade o your post (i applica!le)) (gross) ;ast UN step in your post (i applica!le)) N3ME @F EM:;@&E2) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" @ Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

/ PR>AIOUS POSTS 'IN R>A>RS> OR.>R 9 I > +OST R>C>NT POSTS FIRST( F2@M .@ S3;32'ES :E2 3NNUM FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) Month,&ear Month,&ear Final UN 6rade o your post (i applica!le)) (gross) ;ast UN step in your post (i applica!le)) N3ME @F EM:;@&E2 .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Final (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

<

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Final (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Final (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Final (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) C

EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Final (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Starting Final (gross) (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series :ermanent F.3 S= 455 series 'nde inite .3 UN? 3;D,B55 series =ontinuing SS3 @ther

3DD2ESS @F EM:;@&E2

N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Starting Final (gross) (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or leaving) Supervised) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

F2@M Month,&ear

.@ Month,&ear

S3;32'ES :E2 3NNUM Starting Final (gross) (gross)

N3ME @F EM:;@&E2

FUN=.'@N3; .'.;E) 3s speci ied in your ;etter o 3ppointment,=ontract) UN 6rade o your post (i applica!le)) ;ast UN step in your post (i applica!le)) .&:E @F 9US'NESS) EM:;@&MEN. .&:E) Full time) :art .ime) (A) Type o" contract: +55 Series 455 series 3;D,B55 series :ermanent 'nde inite =ontinuing F.3 .3 SS3 S= UN? @ther N3ME @F SU:E2?'S@2) Email 3dd" and,or .elephone No" o Supervisor)

3DD2ESS @F EM:;@&E2

Num!er o :ro essional Sta 2eason or Supervised) leaving) Num!er o Support Sta Supervised) DES=2':.'@N @F &@U2 DU.'ES 3ND 2E;3.ED 3==@M:;'S#MEN.S

4F" #ave you any o!Gections to our ma$ing inquiries o ) (a) your present employer% No (!) previous employers% No &es

&es

4H" 3re you now1 or have you ever !een1 a permanent civil servant employee in your government% No &es ' answer is (yes(1 W#EN% B5" 2e erences) list three persons not related to you who are amiliar with your character and quali ications and who may !e contacted or a re erence FU;; N3ME FU;; 3DD2ESS1 including E8M3'; 3DD2ESS and .E;E:#@NE NUM9E2 9US'NESS @2 @==U:3.'@N

B+" State any other relevant acts in support o your application" 'nclude in ormation regarding any residence outside the country o your nationality B4" #ave you ever !een convicted1 ined1 or imprisoned or the violation o any law (e*cluding minor tra ic violations)% No &es ' /&es0 give ull particulars o each case in an attached statement BB" #ave you ever !een imposed disciplinary measures1 including dismissal or separation rom service1 on the grounds o misconduct% No &es ' /&es0 give ull particulars o each case in an attached statement B<" #ave you ever !een separated rom service on the ground o unsatis actory per ormance% No &es ' /&es0 give ull particulars o each case in an attached statement

BC" ' certi y that the statements made !y me in answer to the oregoing questions are true1 complete and correct to the !est o my $nowledge and !elie " ' understand that any misrepresentation or material omission made on the UN Women :ersonal #istory Form may lead to the termination o the appointment or to dismissal" ' understand this also applies to any other in ormation or document requested !y the @rgani>ation or the purpose o my recruitment to and employment with UN Women" .?T>) SI5N?TUR>) IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

Note: &ou may !e requested to provide documentary evidence o the statements you have made a!ove" Do not1 however1 send any documentary evidence until you have !een as$ed to do so and1 in any event1 do not su!mit the originals o any re erences1 testimonials or certi icates o academic achievement unless they have !een o!tained or the sole use o UN Women"