INSTRUCTIONS

Please answer each question clearly and completely. 
Type or print in ink. Read carefully and follow all directions.
	
UNITED NATIONS
 
PERSONAL HISTORY
	Do Not Write In This Space	
1. Family Name		First Name		Middle Name		Maiden name, if any

2. Date	Day	Mo.	Yr.
   of
   Birth:   	3. Place of birth

   	4. Nationality(ies) at birth

   	5. Present nationality(ies)

   	6. Sex

7. Height

   	8. Weight

	9. Marital status:
	Single x	Married  o	Separated  o	Widow(er)  o	Divorced o
	
10.	Entry into United Nations service might require assignment and travel to any area of the world in which the United Nations might have responsibilities. Have you any disabilities which might limit your prospective field of work or your ability to engage in air travel?
		YES  o	NO  x	If "yes", please describe.

11.	Permanent address

	12.	Present address (if different)

	13.	Office Telephone No.

15.	Have you any dependents?
			YES o	NO x  If the answer is "yes", give the following information:	
NAME	Date of Birth	Relationship	NAME	Date of Birth	Relationship	

						
16.	Have you taken up legal permanent residence status in any country other than that of your nationality?	YES o	NO x	If answer is "yes", which country?	
17.	Have you taken up any legal steps towards changing your present nationality?	YES o	NO x
	If answer is "yes", explain fully:	
18.	Are any of your relatives employed by a public international organization?
	If answer is "yes", give the following information:		YES o		NO x	
NAME	Relationship	Name of International Organization	

19.	What is your preferred field of work?   COMPUTERS/EDP
	
20.	Would you accept employment for less than 	six months?	  YES x	NO o
	21.	Have you previously submitted an application for employment 	with U.N.? If so when?  	
22.	KNOWLEDGE OF LANGUAGES. What is your mother tongue?  ENGLISH	
	READ	WRITE	SPEAK	UNDERSTAND	
OTHER LANGUAGES	Easily	Not Easily	Easily	Not Easily	Easily	Not Easily	Easily	Not Easily	

									
									
23.	For clerical grades only
	Indicate speed in words per minute.	23a. (For all applicants): 
List the computer software you are familiar with.	

Typing 
Shorthand	English	French	Other languages		

					

						
										P.11 (2-74). E.

24.	EDUCATION. Give full details - N.B.	Please give exact titles of degrees in original language.
					Please do not translate or equate to other degrees.
	A. UNIVERSITY OR EQUIVALENT	
NAME, PLACE AND COUNTRY	ATTENDED FROM/TO	DEGREES and ACADEMIC
DISTINCTIONS OBTAINED	MAIN COURSE OF STUDY	
	Mo./Year	Mo./Year			

					
B.	SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION FROM AGE 14 (e.g. high school, technical school or apprenticeship)	
NAME, PLACE AND COUNTRY	TYPE	ATTENDED FROM/TO	CERTIFICATES OR 
DIPLOMAS OBTAINED	
		Mo./Year	Mo./Year		

						

25.	LIST PROFESSIONAL SOCIETIES AND ACTIVITIES IN CIVIC, PUBLIC OR INTERNATIONAL AFFAIRS

	

	
	
26.	LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN (Do not attach)

	
	
27.	EMPLOYMENT RECORD: Starting with your present post, list in reverse order every employment you have had. Use a separate block for each post. 	Include also service in the armed forces and note any period during which you were not gainfully employed. If you need more space, attach additional pages of the same size. Give both gross and net salaries per annum for your last or present 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 OF EMPLOYER:

	NAME OF SUPERVISOR:
	
	NO. AND KIND OF EMPLOYEES 
SUPERVISED BY YOU
	REASON FOR LEAVING:

DESCRIPTION OF YOUR DUTIES	

 B. PREVIOUS POSTS (IN REVERSE ORDER)
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR

	MONTH/YEAR
	STARTING
	FINAL
		
NAME OF EMPLOYER:  	TYPE OF BUSINESS:  	
ADDRESS OF EMPLOYER:

	NAME OF SUPERVISOR: 
	
	NO. AND KIND OF EMPLOYEES 
SUPERVISED BY YOU:  	REASON FOR LEAVING: 	
	DESCRIPTION OF YOUR DUTIES	

FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR

	MONTH/YEAR

	STARTING

	FINAL

NAME OF EMPLOYER: 	TYPE OF BUSINESS:  	
ADDRESS OF EMPLOYER:

	NAME OF SUPERVISOR: 
	
	NO. AND KIND OF EMPLOYEES 
SUPERVISED BY YOU:  	REASON FOR LEAVING	
DESCRIPTION OF YOUR DUTIES	

	
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR
	MONTH/YEAR
	STARTING
	FINAL
		
NAME OF EMPLOYER: 	TYPE OF BUSINESS:  
	
ADDRESS OF EMPLOYER: 

.	NAME OF SUPERVISOR:  
	
	NO. AND KIND OF EMPLOYEES 
SUPERVISED BY YOU:  	REASON FOR LEAVING	
DESCRIPTION OF YOUR DUTIES	

	
FROM	TO	SALARIES PER ANNUM	EXACT TITLE OF YOUR POST:

MONTH/YEAR

	MONTH/YEAR

	STARTING

	FINAL

NAME OF EMPLOYER:  	TYPE OF BUSINESS:  
	
ADDRESS OF EMPLOYER:
	NAME OF SUPERVISOR:  
	
	NO. AND KIND OF EMPLOYEES SUPERVISED BY YOU:  	REASON FOR LEAVING:
	
DESCRIPTION OF YOUR DUTIES	

	
28.	HAVE YOU ANY OBJECTIONS TO OUR MAKING INQUIRIES OF YOUR PRESENT EMPLOYER?		YES o		NO x
	
29.	ARE YOU NOW, OR HAVE YOU EVER BEEN, A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENT'S EMPLOY?		YES o	NO x
	If answer is "yes", WHEN?
	
30.	REFERENCES:	List three persons, not related to you, who are familiar with your character and qualifications.
		Do not repeat names of supervisors listed under Item 27	
FULL NAME	FULL ADDRESS	BUSINESS OR OCCUPATION	

			
31.	STATE ANY OTHER RELEVANT FACTS. INCLUDE INFORMATION REGARDING AND RESIDENCE OUTSIDE THE COUNTRY OF YOUR NATIONALITY.

	

32.	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 (exclude minor traffic violations)?
							YES o		NO x
	If "yes", give full particulars of each case in an attached statement.

	

33.	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. I understand that any misrepresentation or material omission made on a Personal History form or other document requested by the Organization renders a staff member of the United Nations liable to termination or dismissal.

	DATE: ________________________________	SIGNATURE: ___________________________________________________________

N. B.	You will be requested to supply documentary evidence which supports the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so by the Organization and, in any event, do not submit the original texts of references or testimonials unless they have been obtained for the sole use of the Organization.