Personal History Form
Personal History Form
Personal History Form
3. A) Present Residence (Specify City, Province or State, Country) B) Since (date) Until (anticipated date) C) Telephone No.
E) Passport or Identity Card No. Date of Issue/Date of Expiry Place of Issue (in full)
Male |__| Female |__| Single |___| Married |__| Widow(er) |__| Divorced |__ Separated |__|
7. Have you any depedents? Yes |___| No |___| If answer is "Yes" give following information:
Name Age Relationship Name Age Relationship
8. LANGUAGES
(List mother tongue first)
READ WRITE SPEAK
Language
Excellent Good Poor Excellent Good Poor Excellent Good Poor
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9. EDUCATION: Give full details, using the following space in so far as it is appropriate of schools or other formal training or education from age 14 (e.g. high
school, technical school, apprenticeship, university or its equivalent):
Years attended Certificates, diplomas, degrees or
Name and Place Type
From To academic distinctions obtained
12. List activities in civic, public or international affairs and name any significant publications you have written.
15. In the event of your being selected, how much notice would you need before appointment?
16. Have you any objections to our making inquiries of your present employer? Yes |___| No |___|
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17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged,accounting
fully for your time. List military service and any period of unemployment of more than six months' duration. Use a separate block for each period
and additional sheets if necessary.
Present or most recent occupation Description of duties and responsibilities
Dates Annual emoluments:
From To
Salary
(month/year) (month/year)
Allowances
Total
Business or organization (name and address, including city)
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17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged,accounting
fully for your time. List military service and any period of unemployment of more than six months' duration. Use
Allowances
Total
Business or organization (name and address, including city)
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17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged,accounting
fully for your time. List military service and any period of unemployment of more than six months' duration. Use
Allowances
Total
Business or organization (name and address, including city)
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18. 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 17.
Name in full Complete Address (Telephone No. if known) Business or Occupation
19. (a) Have you ever been arrested, indicted or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned or placed
on probation in connection with such a proceeding, or have you ever been arrested or required to deposit bail or collateral for the violation of any law or
regulation, civil or military (excluding traffic violations)?
(b) If your answer is ''Yes'' under item 19 (a) above, attach separate sheet giving details of all arrests and fines other than minor traffic violations. Specify
charge, date, place where arrested, and disposition.
20. State any other relevant facts. Include information regarding any residence or prolonged travel abroad, give dates, areas, purpose, etc. State any
significant experience not included in Section 17 which you believe will serve in the evaluation of your record.
21. State any disabilities which might limit the performance of your work.
(Appointment is subject to compliance with medical requirements.)
Having answered every question above, I, the undersigned, declare that the information contained in this form is, to the best of my knowledge, true,
complete and accurate, knowing that, if employed, any false declaration or concealment of material facts may result in disciplinary action including
dismissal.
PLEASE NOTE
Applications will not, as a general rule, be valid or retained by the Organization for more than one year from date of receipt. While you may rest assured that
your candidature will be carefully examined, receipt of this form will not be acknowledged, and any further correspondence will be initiated by the
Organization.
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