ORGANISATION FOR THE PROHIBITION OF CHEMICAL WEAPONS
OPCW
PERSONAL HISTORY FORM

INSTRUCTIONS

Please answer each question clearly and completely.

Type or print in black ink.

1. Title (Circle one)
 Mr   Mrs   Ms   Miss   Dr   Prof

Family name

First name

Middle name

2. Sex

3. Date of Birth    

Day         Month          Year

4. Country & City of birth

5. Country/countries of citizenship at birth

6. Current citizenship*

7.  Passport No.

8. A.  Height

8. B. Weight

9. Marital status
    Single

Married

Separated

Widow(er)

Divorced

10. Entry into OPCW service might require assignment and travel to any area of the world in which the OPCW might have
      responsibilities.  Have you any disabilities which might limit your prospective field of work or your ability to engage in travel? 

      YES              NO       If "YES", please describe.

11. Permanent address | 12. Present address ( if different ) | 13. Office Address
Telephone No.: | Telephone No.: | Telephone No.:
Fax No.: | Fax No.: | Fax No.:
E-mail Address: | E-mail Address: | E-mail Address:
14. Do you have any dependents ?         YES                         NO                  If "YES", give the following information:
NAME | Date of Birth | Relationship | NAME | Date of Birth | Relationship

15. Have you taken up legal permanent residence status in any country other than that of your citizenship?          YES                 NO     
      If "YES", which country ?

16. Are any of your relatives employed by a public international organisation?  YES    NO    If "YES", give the following information:
NAME | Relationship | Name of International Organisation
17.  For which position(s) are you applying?
Position Title(s) | Vacancy Reference(s)
1. | 1.
2. | 2.
3. | 3.

18. Would you accept employment for less than
      six months ?        YES                 NO

19. Have you previously submitted an application for employment with OPCW?
       YES                 NO          If so, when ?

20. KNOWLEDGE OF LANGUAGES         A.  What is your mother tongue ?	___________________________________________
| READ | WRITE | SPEAK | UNDERSTAND

B.  OTHER LANGUAGES

Easily

Not
Easily

Easily

Not
Easily

Fluently

Not
Fluently

Easily

Not
Easily

1. | | | | | | | |
2. | | | | | | | |
3. | | | | | | | |
4. | | | | | | | |
*Note:  Please state all citizenships  you currently hold.					

21. EDUCATION.  Give full details 
      A. UNIVERSITY OR EQUIVALENT

N.B.  Please give exact titles of degrees in original language as well as approximate equivalent in English.

NAME,  PLACE AND COUNTRY | ATTENDED FROM/TO | DEGREES and ACADEMIC DISTINCTIONS OBTAINED | MAIN COURSE OF STUDY
| Mo./Year | Mo./Year | |
B. SCHOOLS OR OTHER EDUCATION FROM AGE 14 (e.g. high school, vocational school or apprenticeship)
NAME, PLACE AND COUNTRY | TYPE | ATTENDED FROM/TO | CERTIFICATES OR DIPLOMAS OBTAINED
| | Mo./Year | Mo./Year |
C. OTHER TRAINING COURSES
NAME, PLACE AND COUNTRY | TYPE | ATTENDED FROM/TO | CERTIFICATES OR DIPLOMAS OBTAINED
| | Mo./Year | Mo./Year |

22. For clerical/administrative/secretarial positions only -
       indicate speed in words per minute.

List any computer software programmes you can use.

| English | Other Languages | | |
Typing | | | | | |
Shorthand | | | | | |
23. LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN   (You may attach a separate sheet listing your publications.  Do NOT attach copies of publications themselves.)

24. EMPLOYMENT RECORD: Starting with your present post, list and describe in reverse order every employment you have had in order to facilitate an assessment of how your experience meets specific job requirements. 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 | GROSS SALARIES PER ANNUM | EXACT TITLE OF YOUR POST:
MONTH/YEAR | MONTH/YEAR | STARTING | FINAL |
NAME OF EMPLOYER: | TYPE OF BUSINESS:
| NAME OF SUPERVISOR:
ADDRESS OF EMPLOYER: | NO. AND KIND OF EMPLOYEES SUPERVISED BY YOU: | REASON FOR LEAVING:
DESCRIPTION OF YOUR DUTIES

24. EMPLOYMENT RECORD:  
    
  B. PREVIOUS POSTS

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

25. HAVE YOU ANY OBJECTIONS TO OUR MAKING INQUIRIES OF YOUR PRESENT EMPLOYER?		YES        NO
26. DO YOU OBJECT TO RECEIVING FAXES/LETTERS FROM OPCW AT YOUR PLACE OF EMPLOYMENT?	YES        NO

27. ARE YOU NOW, OR HAVE YOU EVER BEEN, A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENT'S EMPLOY?

              YES                  NO            If "YES",  when?

28. REFERENCES:   List three persons, not related to you, who are familiar with your character and qualifications.
FULL NAME | ADDRESS | BUSINESS OR OCCUPATION

Telephone No.
Fax No.

Telephone No.
Fax No.

Telephone No.
Fax No.

29. STATE ANY OTHER RELEVANT FACTS.  INCLUDE INFORMATION REGARDING ANY RESIDENCE OUTSIDE THE COUNTRY OF  
       YOUR CITIZENSHIP.

30. 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", give full particulars (such as dates, charges, results) of each case in an attached statement.

31. 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 
      Organisation renders me liable to termination or dismissal.

NAME (print or type):_______________________________________	SIGNATURE: ________________________________________

DATE: __________________________________________________

32. Please indicate whether you have any objection against the OPCW forwarding your application to another international organisation
      or OPCW Member State?
                                                                              YES                            NO

33. 	Please do not attach educational certificates or any other documentation to this form. Short-listed candidates will be required to produce evidence of
academic achievement.

	Only candidates under serious consideration for a post will be contacted.