1420 Form

RPTW-PCTV EMPLOYEE/CONSULTANT BIOGRAPHICAL DATA SHEET
1. Name (Last, First, Middle) Ahmad, Ali 2. Contractors Name RPTW-PCTV 4. Contract Number CA 391-A-00-10-01161-00 6. Proposed Salary <To be filled by HR> 8. Telephone Number (include area
code)
3. Employees/Consultants Address (include ZIP code)
5.
Position Under Contract
7. Duration of Assignment <To be filled by HR>
9. Place of Birth Dera Ghazi khan
10. Citizenship Pakistani
11. Names, Ages and Relationship of Dependents (If any)
12. EDUCATION
(include all college or university degrees) MAJOR SUBJECT HRM Marketing DEGREE MS BBA (4Years) FSc DATE 2011 2009
13. LANGUAGE PROFICIENCY (To complete this

section please refer to the instructions page 2) LANGUAGE PROFICIENCY PROFICIENCY SPEAKING READING
NAME AND LOCATION OF INSTITUTION SZABIST (Islamabad) BZU (Multan) BISE Dera Ghazi Khan
Pre2003 Engineering 14. EMPLOYMENT HISTORY
1. 2.
Give last three occupations. List salaries separate for each occupation. Continue on separate sheet of paper if required to list all employment related to duties of proposed assignment. Salary definition basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions consultant fees, extra or overtime work payments, overseas differential or quarters, cost of living or dependent education allowances.
POSITION TITLE
EMPLOYERS NAME AND ADDRESS POINT OF CONTACT &TELEPHONE #
DATES OF EMPLOYMENT (MM/DD/YY) FROM TO
ANNUAL SALARY PKR (Please give a specific breakdown of your salary (Net Salary + other benefits)
15. SPECIFIC CONSULTANT SERVICES (give last three (3) consultancy services) SERVICES PERFORMED CONTRACTORS NAME AND ADDRESS DATES OF DAILY POINT OF CONTACT &TELEPHONE # CONSULTANCY RATE (MM/DD/YY) PKR FROM TO
TOTAL IN PKR
16. CERTIFICATION:
To the best of my knowledge, the above facts as stated are true and correct.
Contractor certifies in submitting this form that it has taken reasonable steps (in accordance with sound business practices) to verify the information contained in this form. Contractor understands that RPTW-PCTV may rely on the accuracy of such information in negotiating and reimbursing personnel under this contract. The making of certifications that are false, fictitious, or fraudulent, or that are based on inadequately verified information, may result in appropriate remedial action by RPTW-PCTV, taking into consideration of all of the pertinent facts and circumstances, ranging from refund claims to criminal prosecution. Signature of Contractors Representative Date
INSTRUCTIONS Indicate your language proficiency according to the proficiently level described. There are 4 levels. Each level is described and illustrated by examples for both Speaking (S) and Reading (R) 1. S R Working proficiency Able to satisfy routine social demands and limited work requirements. Sufficient comprehension to read simple, authentic written material in a form equivalent to usual printing or type script on familiar subjects. Professional proficiency A Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations. Able to read within a normal range of speed and with almost complete comprehension. Professional proficiency B Able to use the language fluently and accurately on all levels. Nearly native ability to read and understand extremely difficult or abstract prose, colloquialisms and slang. Functional proficiency Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker. Reading proficiency is functionally equivalent to that of the well-educated native reader. PAPERWORK REDUCTION ACT INFORMATION The information requested by this form is necessary for prudent management and administration of funds under RPTW-PCTV contracts. The information helps RPTW-PCTV estimate overseas logistic support and allowances; the educational information provides an indication of qualifications; the salary information is used as a means of cost monitoring and to help determine reasonableness of proposed salary. PAPERWORK REDUCTION ACT NOTICE Public reporting burden for this collection of information is estimated to average thirty minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: RPTW-PCTV, Email: [email protected]
2. S
R 3. S R 4. S R

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RPTW-PCTV EMPLOYEE/CONSULTANT BIOGRAPHICAL DATA SHEET

3. Employees/Consultants Address (include ZIP code)

Position Under Contract

7. Duration of Assignment <To be filled by HR>

9. Place of Birth Dera Ghazi khan

10. Citizenship Pakistani

11. Names, Ages and Relationship of Dependents (If any)

13. LANGUAGE PROFICIENCY (To complete this

Pre2003 Engineering 14. EMPLOYMENT HISTORY

EMPLOYERS NAME AND ADDRESS POINT OF CONTACT &TELEPHONE #

DATES OF EMPLOYMENT (MM/DD/YY) FROM TO

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