Position Applying for / :
Level/Grade / : / Application Source / :
Division/Project / : / Location/Base / :

Personal Details

2012

Full Name / :
Father’s/Mother’s/Spouse’s Name / :
Sex / :
Nationality / :
Date of Birth / :
Special Identification marks / :
E-mail Address :
Telephone / :
Mobile Number / :
Permanent Address (District, Municipality/VDC, Ward No) / :
Present Address (District, Municipality/VDC, Ward No) / :
Family Members / : / (Spouse/Children/Parents) Note: Brothers/sisters/other relations may NOT be included as family members
Name / Age / Relationship with Employee / Whether staying with employee or Not
( Yes or No)
Yes No
Yes No
If you have worked with us before, please state when and in what capacity.

Education Background

Please start with the most recent up to class ten, including any current studies.

Degree/Diploma/certificate / Year of Completion / School/College/Institute / Board/University/Institute / Subjects / Division/Marks

(Please add additional rows to the table if required)

Training Exposure:

Include any job training, as well as formal training, that is relevant to the job for which you are applying.

Nature/Course or Description of Training / Organizing Agency / Year

Membership of Professional/Academic Associations

Name of Body
1st Registration date / Registration No. / Renewal date

Awards/Prizes won:

Hobbies and Interest :

Skills

Languages Known: Please tick (√)

Language / Read / Write / Speak / Understand

(use additional sheets if required)

Computer skills: Please indicate your skill levels with tick (√) in the relevant column.

Software / Basic / Intermediate / Advanced

(use additional sheets if required)

Publications:

(use additional sheets if required)

Work Experience/ Employment History : From first Job onwards)

Current or most recent employment

Employer’s name and address / Your job title
Employment Period From (mm/yy)
Employment Period To (mm/yy)
Notice period
Nature of Employer’s business / Reasons for leaving/seeking change
Brief Description of Responsibilities & Achievements/Assignment Undertaken:

Previous employment Please continue on a separate document if necessary and at least fill out five previous employments.

Employer’s name / Location
From / To / Your job title
Brief Description of Responsibilities & Achievements/Assignment Undertaken:
Nature of Employer’s business / Reasons for leaving
Employer’s name / Location
From / To / Your job title
Brief Description of Responsibilities & Achievements/Assignment Undertaken:
Nature of Employer’s business / Reasons for leaving
Employer’s name / Location
From / To / Your job title
Brief Description of Responsibilities & Achievements/Assignment Undertaken:
Nature of Employer’s business / Reasons for leaving

(use additional sheets if required)

OTHER INFORMATION

Periods unaccounted for in employment history (e.g. career breaks, unemployment etc.)

Year ( From – to) / Organization / Designation: Nature of assignments undertaken

(use additional sheets if required)

Any Other Information that the Applicant May like to Add

STATEMENT OF SUITABILITY

Reasons for Application

Please demonstrate how you meet the requirements of the person specification by providing details of your experience, skills and knowledge gained in employment, voluntary work or other experience.

We will use the information you provide to decide whether or not to shortlist you for interview.

Please note - Your supporting statement must be no longer than two sides of A4 in Arial font, size 12.

References

Please give the names of three people who are able to provide references relating to your work experience and to your suitability for the post applied. One referee must be your current or most recent employer.

SN / Name of Referee / Latest Position and Organization / Tel/Mobile and e-mail
1
2
3

Disclosure of Criminal Convictions

Have you any unspent convictions?

Yes No

Please provide details.

(use additional sheets if required)

Signature

Please read the following points before signing below.

1.  FPAN is a national service provider of sexual and reproductive health and rights for all. FPAN needs to ensure that you are aware of:

(a)  FPAN has a goal of universal recognition of a woman’s right to choose and have access to safe abortion.

(b)  Our work is guided by principles contained in the Code of Good Practice for Employee Responding to HIV Workplace; Child Protection Policy and Sexual Harassment. If successful you will be expected to work within these guidelines.

I confirm I have read and understood the above. Yes No

2.  To comply with the requirements of the Migration Act, all candidates invited for interview will be required to produce original document/s to prove their eligibility to work in Nepal.

3.  By communicating the information on this form to FPAN by means of electronic communication, I hereby indicate that I intend the information on this form to be taken as bearing my signed name or signature as evidence of my intention to be bound by the form and evidence of my assertion of the veracity of the information I have provided on this form.

4.  I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.

Signature / To return this form along with signed latest CV to the office.
or
email
Date

Thank you for completing the application form.