Resume Format

(For Empanelment asAssessor)

  1. Name: ______
  1. Date of Birth:______
  1. Designation:______

Organization Address:______

______

______Pin Code______

Tel. No.:______Fax No. ______

Email address:______

  1. Educational Qualifications

Period / Board/ University / Qualification / Educational Institution and Address / Subjects / Grade
  1. Registered/ recognized training courses attended:

S.No. / Title of the Course / Conducted/ Organized by (Name and Address) / Dates / Result
From / To
  1. Membership of Professional Bodies

S.No. / Professional Body (Name and Address) / Membership / Valid Till
Grade / No.
  1. Experience

a)Generalincluding in the field of Environment :

Period / Organization with Address / Department / Designation / Role/ Responsibilities

b)Specific Experience – in field of Environmental Impact Assessment :

Period / Organization with Address / Department / Designation / Role/ Responsibilities / Project Sector/s or Functional Area/s covered as per Annexure 1
  1. Please tick mark your experience in EIA making in sector/ s or functional areas as per attached sheet (Annexure 1)
  2. Three references

Name of reference / Name of organisation, designation / Known since and relation / Contact details , address, phone, email , cell no. etc.
  1. Declaration by Candidate

I attest that the above information relating to my education, experience and declaration (Annexure 2) is correct. I do understand the significanceof this taskand any incorrect information by me would result in my ineligibility.

SignatureDate

Annexure 1

Project Sectors – Annexure III A

S. No. / Sectors / Expertise available
(Yes/ No)
Related to EIA / Others
1 / Mining of minerals including Opencast / Underground mining
2 / Offshore and onshore oil and gas exploration, development & production
3 / River Valley, Hydel, Drainage and Irrigation projects
4 / Thermal Power Plants
5 / Nuclear power projects and processing of nuclear fuel
6 / Coal washeries
7 / Mineral beneficiation including pelletisation
8 / Metallurgical industries (ferrous & non ferrous) – both primary and secondary
9 / Cement plants
10 / Petroleum refining industry
11 / Coke oven plants
12 / Asbestos milling and asbestos based products
13 / Chlor-alkali industry
14 / Soda ash Industry
15 / Leather/skin/hide processing industry
16 / Chemical fertilizers
17 / Pesticides industry and pesticide specific intermediates (excluding formulations)
18 / Petro-chemical complexes (industries based on processing of petroleum fractions & natural gas and/or reforming to aromatics)
19 / Textile – cotton and manmade fibers
20 / Petrochemical based processing (processes other than cracking & reformation and not covered under the complexes)
21 / Synthetic organic chemicals industry (dyes & dye intermediates; bulk drugs and intermediates excluding drug formulations; synthetic rubbers; basic organic chemicals, other synthetic organic chemicals and chemical intermediates)
22 / Distilleries
23 / Integrated paint industry
24 / Pulp & paper industry excluding manufacturing of paper from wastepaper and manufacture of paper from ready pulp with out bleaching
25 / Sugar Industry
26 / Induction/arc furnaces/cupola furnaces/submerged arc furnace/crucible furnace/re-heating furnace of capacity more than 5Tonne per heat
27 / Oil & gas transportation pipeline (crude and refinery/ petrochemical products), passing through national parks/ sanctuaries/coral reefs /ecologically sensitive areas including LNG terminal
28 / Isolated storage & handling of Hazardous chemicals (As per threshold planning quantity indicated in column 3 of schedule 2 & 3 of MSIHC Rules 1989 amended 2000)
29 / Air ports
30 / All ship breaking yards including ship breaking units
31 / Industrial estates/ parks/ complexes/areas, export processing Zones(EPZs), Special Economic Zones(SEZs), Biotech Parks, Leather Complexes
32 / Common hazardous waste treatment, storage and disposal facilities (TSDFs)
33 / Ports, harbours, jetties, marine terminals, break waters and dredging
34 / Highways, railways, transport terminals, mass rapid transport systems
35 / Aerial ropeways
36 / Common Effluent Treatment Plants (CETPs)
37 / Common Municipal Solid Waste Management Facility (CMSWMF)
38 / Building and large construction projects including shopping malls, multiplexes, commercial complexes, housing estates, hospitals, institutions
39 / Townships and Area development projects
40 / Additional Sectors:
  1. Automobile and Auto Components

  1. Electroplating and Metal Coating

  1. Electrical and Electronics including component industry

  1. Glass and Ceramic Industry

  1. Food Processing

Functional Areas:

S. No. / Functional Area / Meeting qualification requirements of EIA Scheme Rev. 09 (Appendix 1)
Yes/ No / Expertise available
(Yes/ No)
Related to EIA / Others
1 / Land Use
2 / Air Pollution Prevention, Monitoring & Control
3 / Meteorology, Air Quality Modeling & Prediction
4 / Water Pollution Prevention, Control & Prediction of Impacts
5 / Ecology and Biodiversity
6 / Noise / Vibration
7 / Socio-Economic aspect
8 / Hydrology, Ground Water & Water Conservation
9 / Geology
10 / Risk Assessment & Hazard Management
11 / Solid Waste and Hazardous Waste Management
12 / Soil Conservation

Annexure 2

DECLARATION BY THE CANDIDATE OF NON-INVOLVEMENT IN EIA MAKING PROCESS

This is to confirm that I……………………………..……………and my immediate relatives arecurrently not involved directly/ indirectly in the process of EIA making either myself or for any organization.

I also commit here that in case I get involved in future in the process of EIA making, I would inform QCI prior to accepting such assignments.

Name …………………………………………

Date …………………………………………

Sign ……………….………………………..

Resume Format/Empanelment as Assessor/Rev. 00/Apr. 2013