ICS Team Leaders Application Form

Rwanda

ICS Team Leaders Application form

This application form must be completed by applicants for Team Leaders position.

ICS is open to young people from:

·  23 to 35 years old for the position of Team Leaders

For more information please consult http:// www.internationalservice.org.uk/

1.  Title / Mr / Mrs / Mss / Dr
2.  Name / 3.  First name (s)
4.  Email / 5.  Skype
6.  Tel/mobile. 1 / 7.  mobile2
8.  How would you like to be contacted?
9.  PO box
10.  Address (Cell, Avenue, Street)
11.  City / 12.  District
13.  Province / 14.  Country

Personal Information

Volunteers should permanently live in the implementation area

1.  Date of birth / Day / Month / Year
2.  Nationality
3.  Do you also have Rwandan nationality? / Yes / No
4.  In case you are note Rwandan did you have permanent resident in Rwanda / Yes / No

ICS is an inclusive programme. Could you please answer the following question?

5.  Do you consider yourself as a disabled people? / Yes / No
6.  Do you have any health issue or disability that would require any more support? / Yes / No
If yes please what could we do to ensure your full participation to each stage of ICS journey?
7.  Sex / Male / Female
8.  Religion

Motivation

1.  Why do you want to be an ICS Team Leaders? What experience of leading and supporting young people do you have?
2.  Could you provide some example of your experience of volunteering or supporting other people? For example, community outreach action,community work, a member of an association
3.  What is your current occupation?
Student full time / Student part time / intern / Studies accomplished
Employee full time / Employee part time / Volunteer / unemployed
4.  What career or studies do you plan to do after your ICS placement?
Long lasting Problem solving
5.  Are you free from any other commitment to be engaged fully in this programme for 6 months? / Yes / No
6.  Your availability date for a placement: / Day / Month / Year
7.  How did you hear aboutICS programme?
Radio / Internet / ICS Volunteers
International Service implementation partners / International Service / friend
8.  Language knowledge
Language / Basic (written and spoken) / OK (written and spoken) / Fluency (written and spoken)
Kinyarwanda
English
French
9.  Studies/ skills / 10.  Certificates obtained
11.  Professional experience (internship, volunteering, work experience)

Emergency contact person

1st emergency contact details

1.  Title / Mr / Mrs / Mss / Dr
2.  Name / 3.  First Name(s)
4.  Email
5.  Tel. / 6.  Mobile 2
7.  Relationship with this person
8.  PO Box
9.  Address (cell, avenue, street)
10.  City / 11.  District
12.  Province / 13.  Country

2nd emergency contact details

1.  Title / Mr / Mrs / Mss / Dr
2.  Name / 3.  First Name(s)
4.  Email
5.  Tel. / 6.  Mobile 2
7.  Relationship with this person
8.  PO Box
9.  Address (Cell, Avenue, Street)
10.  City / 11.  District
12.  Province / 13.  Country

Date: Signature:

NB: Please note that when you will be selected you will be asked to provide a health check/CertificatVisiteMédicale and a Police record /CasierJudiciaire.

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