APPLICATION FORM
INSTRUCTIONS
Please answer each question clearly and completely.Read carefully and follow all directions.Application deadline:January18, 2010
1. Family name / First name: / Middle name: / Maiden name, if any
2. Date of Birth: / 3. Place of birth : /
- Nationality(ies)
5. Sex / 6. Do you hold a current passport?
Yes No
If yes: Issuing country ______
Date of issue: ______Expiration date: ______
7. Current mailing address Street or PO#CityState/CountryMail code
8. Alternate address Street or PO#CityState/CountryMail code
9. Home Telephone No. 10. Mobile Telephone No.
11. Office Telephone No. 12. Email address
Please attach any additional information on how you may best be contacted by the UNMIT. Please note that it is YOUR responsibility to notify UNMIT with any change in your contact information.
13. EDUCATION.
Name of high school: Location:Date of graduation:
Please list in order of your attendances all universities or colleges in which you have enrolled
Name of University/College / Location
(city, state or country) / Date / Major / Degree or Diploma received / Date Degree received
From
mo/yr / To
mo/yr
What scholarships, fellowships or grants have you held (if any)? / If you have traveled or lived in any country other than Timor-Leste, please indicate places and dates:
14. Knowledge of Languages: PLEASE LIST ANY FOREIGN LANGUAGES YOU HAVE STUDIED AND INDICATE LEVEL COMPLETED
Language / 1st Year / 2nd Year / 3rd Year / 4th Year
15. EMPLOYMENT RECORD: Starting with your present post, list IN REVERSE ORDER every employment you have had. Use a separate block for each post.
A. PRESENT POST (LAST POST, IF NOT PRESENTLY IN EMPLOYMENT)
FROM / TO / SALARIES PER ANNUM / EXACT TITLE OF YOUR POST:
MONTH/YEAR / MONTH/YEAR / STARTING / FINAL
NAME OF EMPLOYER: / TYPE OF BUSINESS:
ADDRESS & TEL / FAX OF EMPLOYER : /
NAME OF SUPERVISOR:
NO. and kind of employees supervised by you: / REASON FOR LEAVINGDESCRIPTION OF YOUR DUTIES
B. PREVIOUS POST
FROM / TO / SALARIES PER ANNUM / EXACT TITLE OF YOUR POST:
MONTH/YEAR / MONTH/YEAR / STARTING / FINAL
NAME OF EMPLOYER: / TYPE OF BUSINESS
ADDRESS & TEL / FAX OF EMPLOYER : / NAME OF SUPERVISOR
NO. and kind of employees supervised by you / REASON FOR LEAVING
DESCRIPTION OF YOUR DUTIES
16. REFERENCES. List two persons, not related to you, who are familiar with your character and qualifications.
FILL NAME / FULL ADDRESS, TEL & FAX / BUSINESS OR OCCUPATION
17. Essays. Please write twoessays in your own words to answer each of the following questions to the best of your ability. Remember that these essays will contribute to the selection panel’s evaluation of your suitability as a potential scholarship recipient. Please type or (clearly) print your essays on separate pages and attach them to the Application form.
1. / Please explain what you consider to be the main human rights challenges in Timor-Leste and recommendations on how to address these? (Minimum length: 500 words)
2. / In clear and practical terms, please state your career goals for the first five years after you complete the Master in International Human Rights Law for which you are applying. How has your life to this point contributed to shaping your career goals? (Minimum length: 500 words)
APPLICANT'S CERTIFICATION
I certify that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief and that I have attended no institution other than those listed on this application. I understand that any misrepresentation or material omission made on the Application form or other document requested by HRTJS, UNMIT renders to termination of the scholarship. I understand that it is my responsibility to arrange for the forwarding of official transcripts of records from all schools and colleges attended, and that such transcripts and other application materials become the property of HRTJS, UNMIT and will not be returned to me. (Please be sure that photocopies of your application and other documents needed for your own personal use are made BEFORE submitting them to HRTJS, UNMIT.)DATE: SIGNATURE:______
Addresses for submission of completed applications:
The United Nations Integrated Mission in Timor-Leste (UNMIT), Human Rights and Transitional Justice Section, Obrigado Barracks, Dili, Timor-Leste. For more information, please contact Lilit Umroyan by telephone: (00670) 731 1542 or email to: . Please indicate in the subject line: “Application OHCHR-TIMORLESTE Scholarship 2010”.