GPO Box: 6257, Lazimpath, Kathmandu, Nepal
Email:
1. Application for the Position of:
First Name: / Last/Family Name: / Middle Name:
Gender: / Date of Birth: (dd/mm/yy) / Nationality:
Permanent Address / Current Residence Address (If different from Permanent)
Email: / Contact Phone:
1.
2. / Residence:
Office:
Mobile:
Education Qualification
Give full details- Please give exact titles of degrees in original language.
A. University or equivalent (most recent first) of the educational institutions attended and other specialized courses taken. Give the exact name of institution and title of degree, diplomas, etc. (Please do not translate or equate with other degree.)
Institution / Place and Country / Attended From/To / Certificate / Diplomas / Degrees Obtained / Main Course of Study
Year / Year
B. Schools (10, 10+2 / Intermediate level) including Technical Schools
Institution / Place and Country / Attended From/To / Certificate / Diplomas / Degrees Obtained / Main Course of Study
Year / Year
Have you any relative in ActionAid? List the names if Yes
Languages : List Mother Tongue First
List membership of professional societies and activities in civic, public or international affairs
Professional Experience
Starting with your present post, list in reverse order every employment you have had.
Use separate block for each employment.
1. Present Post (Last Post, if not presently in employment)
Exact Title of Your Current Post : / Name and Address of Employer / Name of Current Supervisor
From
Month / Year / To
Month / Year
Brief Description of Your Current Duties / Any other position held in the current organisation
2. Previous Posts: (In Reverse Order- i.e. Most Recent Posts First)
Exact Title of Your Current Post / Name and Address of Employer / Name of the Supervisor
From
Month / Year / To
Month / Year
Brief Description of Your Current Duties / Any other position held in the current organisation
3
Exact Title of Your Current Post / Name and Address of Employer / Name of the Supervisor
From
Month / Year / To
Month / Year
Brief Description of Your Current Duties / Any other position held in the current organisation
4
Exact Title of Your Current Post / Name and Address of Employer / Name of the Supervisor
From
Month / Year / To
Month / Year
Brief Description of Your Current Duties / Any other position held in the current organisation
5
Exact Title of Your Current Post / Name and Address of Employer / Name of the Supervisor
From
Month / Year / To
Month / Year
Brief Description of Your Current Duties / Any other position held in the current organisation
Award Received if any
Any Significant Publication (do not attach the publication)
Training Attended
Sn. / Name of the
Training / Conducted by (Agency/Individual) / Place / Duration
(List other significant training, that do not have direct relevance to positions applied.)
Field Sites traveled in Nepal
Sn. / Place (VDC/NP) / District / Year Visited / Reason for Travel
Other Countries Visited:
Name of Reference
List three persons, not related to you, who are familiar with your character, qualification and competence and can be reached
One to be of current Supervisor.
Name
Phone
Mobile
Position
Organisation
Nature of Professional relation
Have you any objection to our making inquires with your present employer?
Yes / No
If Yes
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
If Yes
I certify that the statements made by me in answer to the foregoing question are true, complete and correct to the best of my knowledge and belief. I understand that any misrepresentation or material omission made in ActionAid International Nepal Application Form or other document requested by the organisation render me liable to disqualification, termination or dismissal.
Date: Signature
Your motivation to apply for this position?
(You may enter up to 2000 characters. )
AAN Application Form – 2015 Page 2 of 3