CONFIDENTIAL
PERSONAL DETAILS
First name / Surname
Address for correspondence
Tel (day) / Tel (eve) / Mobile
Email: / Skype / DoB / (d/m/y)
Nationality / Passport No. / Expiry date
AVAILABILITY AND RELEASE ARRANGEMENTS
I am available from: ( mm/yyyy) / For up to: (specify number of weeks or months)
Tick the relevant box to indicate how soon you could be deployed uponreceiving formal notification of a humanitarian deployment:
I can be deployed with 24 hour’s notice I can be deployed with 36-48 hours’ notice
I can be deployed with 72 hour’s notice I can be deployed with1 week’s notice
Complete if you will seek release from a current employer. Tick the relevant box to indicate yourpreferred release arrangement:
I will seek paid leave from my employer I will seek unpaid leave from my employer
WORK EXPERIENCE
Please summarise your relevant work experience starting with your most recent role first (cont.. on a separate page if necessary) or refer to work experience/history in attached CV
Dates of employment / Employer’s name / Job title and brief summary of main duties / Reason for leaving
RELEVANT QUALIFICATIONS & TRAINING
Please list any relevant professional qualifications or training courses that you have attended
Dates / Qualification/training course / Provider
LANGUAGE SKILLS
Please list any Pacific language skills you possess and state your level of fluency (fluent, good, working knowledge, basic)
Language/s / Read / Write / Speak
SUPPORTING STATEMENT
Please outline below your reasons for applying to join Oxfam’s Humanitarian Registeralong with any additional information that may support your application; you may wish to refer to relevant experience, achievements, knowledge, professional or personal skills/qualities.
CRIMINAL CONVICTIONS
Please provide details of any unspent convictions. A conviction will not necessarily exclude you from joiningOxfam. We will consider any conviction that may be relevant to a posting with Oxfam overseas.
EMPLOYER RELEASE AGREEMENT
Please complete if you require your employer’s approval to be released for humanitarian deployments with Oxfam
My employer/line managerapproves my application tojoin Oxfam’s Pacific Humanitarian Register and agrees to release me for a maximum of weeks to undertake a humanitarian deployment within a given 12 month period.
Manager’s name / Manager’s job title
Organisation / Manager’s contact details
REFEREE DETAILS
Please provide details of two referees
(line manager or person who can comment on your skills/experience, including relevant emergency response experience)
1. Referee’s name / 2. Referee’s name
Organisation / Organisation
Relationship to you
e.g line manager, colleague
Telephone number / Telephone number
E-mail address / E-mail address
DECLARATION
I confirm that the information contained on this form and any attachments is to the best of my knowledge correct and complete.
I agree that this information may be shared with relevant staff within Oxfam New Zealand, Oxfam Australia or Oxfam in the Pacific. This may result in my being contacted about relevant work, learning & development, and/or media opportunities.
Candidate’s name
Candidate’s signature
(scanned or electronic) / Date
Oxfam HumanitarianApplication form Last updated: Oct-17