United Nations                           Nations Unies

ICTY

	

	

	

PERSONAL HISTORY PROFILE

General Details
Family Name
     	
	First Name
     	Middle Name
     	Maiden name, if any
     	
Date of birth (DD/MM/YYYY)
     
	City of birth
     	Country of Birth
     	
Country of Nationality (at Birth)
     
	Second Nationality (if any)
     	Country of Present Nationality
     	2nd Nationality (if any)
     	
Sex
     
	Height [cm]
     	Weight [kg]
     	
Marital status
Single  	Married  	Separated  	Widow/er  	Divorced 
	
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:      
	
Are there any limitations on your ability to perform in your prospective field of work?
YES  NO  
	
E-mail Address
     
	
Have you taken up any legal steps towards changing your present nationality, explain the circumstances:
     
	
What is your preferred field of work?
     
	
Would you accept employment for less than six months?
YES  NO  
	
If you have previously submitted an application for employment and/or undergone any tests with the United Nations, please indicate when:
     
	
State any other relevant facts, include information regarding any residence outside the country of your nationality:
     
	
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  
Give full explanation of each case:      

Address/es (complete postal address/es please)
Permanent
     

Tel. No.		     
Mobile		     	Present
     

Tel. No.		     
Mobile		     	

Relations
Are any of your relatives employed by a public international organization?
YES  NO  
	
If you have any dependants, list them below:	
Name
     
	Relationship
     	Birth Date
     	Gender
     	City, Country of Birth
     	Nationalities
     	
List any relatives employed by the United Nations or its Specialized Agencies below:	
Name
     
	Relationship
     	Organization
     	

Education

List all UNIVERSITY DEGREES OR EQUIVALENT qualifications obtained.

Give full details - N.B. Please give exact titles of degrees in original language. Please do not translate or equate to other degrees.
	
University or Equivalent	City, Country	Attended From-To	Main Course of Study	Degree or Academic Distinctions Obtained	Exact Title of Degree	
		MM / YYYY	MM / YYYY				
     	     	     	     	     	     	     	
     	     	     	     	     	     	     	
     	     	     	     	     	     	     	
     	     	     	     	     	     	     	
	
List SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION from age 14 (e.g. high school, technical school, or apprenticeship).	
School	City, Country	Attended From - To	Main course of Study	Certificates or Diplomas Obtained	
		MM / YYYY	MM / YYYY			
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	

Publications
List any significant publications you have written.	
Journal/Publisher	Title of Publication	Month of Publication	Year of Publication	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
	
List professional societies and activities in civil, public, or international affairs.
     	

Employment
Starting with your present post (or most recent), 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.
	
From	To	Salaries Per Annum (indicate currency)	Exact Title of Your Post
     	
MM / YYYY
     
	MM / YYYY
     	Starting ( net / gross )
      /      	Final ( net / gross )
      /      		
Name of Employer
     
	Type of Business
     	
Address of Employer
     
	Name of Supervisor
     	
Telephone Number
     
	No. and kind of Employees Supervised by You
     	
Is this a civil servant position of your government?
YES  NO  
	
Description of Your Duties
     	
	
Summary of Achievements 
     

Reason for Leaving
     

From	To	Salaries Per Annum (indicate currency)	Exact Title of Your Post
     	
MM / YYYY
     
	MM / YYYY
     	Starting ( net / gross )
      /      	Final ( net / gross )
      /      		
Name of Employer
     
	Type of Business
     	
Address of Employer
     
	Name of Supervisor
     	
Telephone Number
     
	No. and kind of Employees Supervised by You
     	
Is this a civil servant position of your government?
YES  NO  
	
Description of Your Duties
     	
	
Summary of Achievements 
     

Reason for Leaving
     

From	To	Salaries Per Annum (indicate currency)	Exact Title of Your Post
     	
MM / YYYY
     
	MM / YYYY
     	Starting ( net / gross )
      /      	Final ( net / gross )
      /      		
Name of Employer
     
	Type of Business
     	
Address of Employer
     
	Name of Supervisor
     	
Telephone Number
     
	No. and kind of Employees Supervised by You
     	
Is this a civil servant position of your government?
YES  NO  
	
Description of Your Duties
     	
	
Summary of Achievements 
     

Reason for Leaving
     

From	To	Salaries Per Annum (indicate currency)	Exact Title of Your Post
     	
MM / YYYY
     
	MM / YYYY
     	Starting ( net / gross )
      /      	Final ( net / gross )
      /      		
Name of Employer
     
	Type of Business
     	
Address of Employer
     
	Name of Supervisor
     	
Telephone Number
     
	No. and kind of Employees Supervised by You
     	
Is this a civil servant position of your government?
YES  NO  
	
Description of Your Duties
     	
	
Summary of Achievements 
     

Reason for Leaving
     

From	To	Salaries Per Annum (indicate currency)	Exact Title of Your Post
     	
MM / YYYY
     
	MM / YYYY
     	Starting ( net / gross )
      /      	Final ( net / gross )
      /      		
Name of Employer
     
	Type of Business
     	
Address of Employer
     
	Name of Supervisor
     	
Telephone Number
     
	No. and kind of Employees Supervised by You
     	
Is this a civil servant position of your government?
YES  NO  
	
Description of Your Duties
     	
	
Summary of Achievements 
     

Reason for Leaving
     

From	To	Salaries Per Annum (indicate currency)	Exact Title of Your Post
     	
MM / YYYY
     
	MM / YYYY
     	Starting ( net / gross )
      /      	Final ( net / gross )
      /      		
Name of Employer
     
	Type of Business
     	
Address of Employer
     
	Name of Supervisor
     	
Telephone Number
     
	No. and kind of Employees Supervised by You
     	
Is this a civil servant position of your government?
YES  NO  
	
Description of Your Duties
     	
	
Summary of Achievements 
     

Reason for Leaving
     

Have you any objections to our making inquiries of your present employer?
YES  NO  
	
Other agencies of the United Nations System may be interested in our applicants.  Do you have any objection to your personal history profile being made available to them?
YES  NO  
	
For clerical grades only:
Indicate typing speed in words per minute.	
English	-	     	French	-	     	
List any office machines or equipment you can use:
     

Languages
What is your mother tongue?       	
	Read	Write	Speak	Understand	
Other Languages	Easily	Not Easily	Easily	Not Easily	Easily	Not Easily	Easily	Not Easily	
     									
     									
     									
     									

References
List three persons, not related to you, and not current United Nations staff members, who are familiar with your character and qualifications.  Do not repeat names of supervisors listed under Employment.	
Full Name	Business or Occupation	Telephone Number	Complete Postal Address	E-mail	
     
	     	     	     	     	
     
	     	     	     	     	
     
	     	     	     	     	

   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 this Personal History Profile, 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.