INSTRUCTIONS
Please answer each question clearly and
completely. TYPE OR PRINT LEGIBLY. APPLICATION FORM
Read carefully and follow all directions.
Family name First name Middle name Maiden name, if any
Date of birth (day/month/year) Place of birth Nationality(ies) at birth Present Nationality(ies) Sex
Marital Status:
Single ☐ Married ☐ Separated ☐ Widow(er) ☐ Divorced ☐
Entry into IRENA might require official travel to any area of the world
(a) Are there any limitations on your ability to perform in your prospective field of work? YES/NO
(b) Are there any limitations on your ability to engage in all travel? YES/NO
Permanent address Present address Telephone numbers:
(if different from permanent address) Home;
Telephone No. Work;
Mobile;
Personal and/or professional email address
Do you have any dependent children? Yes ☐ No ☐ If the answer is “yes”, give the following information:
Name of Children Date of Birth (day/month/year) Place of Birth Nationality Gender
Name of Spouse
Have you taken up legal permanent residence status in any country other than that of your nationality? YES/NO
If answer is “yes”, which country?
Have you taken any legal steps towards changing your present nationality? YES/NO
Are any of your relatives employed by IRENA? Yes ☐ No ☐
If answer is “yes”, give the following information:
Name Relationship
What is your preferred field of work?
KNOWLEDGE OF LANGUAGES. What is your mother tongue?
Other languages READ WRITE SPEAK UNDERSTAND
Easily Not Easily Easily Not Easily Fluently Not Fluently Easily Not Easily
ENGLISH
LIST ANY SOFTWARE YOU USE – INCLUDING MS OFFICE – AND ANY SPECIFIC PROGRAMMING LANGUAGES
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 DEGREES and ACADEMIC DISTINCTIONS MAIN COURSE OF STUDY
FROM/TO OBTAINED
Month/Year Month/Year
B. SCHOOLS OR EDUCATION FROM AGE 14 (e.g., high school, technical school)
NAME, PLACE AND COUNTRY TYPE YEARS ATTENDED CERTIFICATES OR
DIPLOMAS OBTAINED
FROM TO
LIST PROFESSIONAL SOCIETIES AND ACTIVITIES IN CIVIC, PUBLIC OR INTERNATIONAL AFFAIRS
LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN (DO NOT ATTACH)
LIST OF PROFESSIONAL TRAINING/COURSES THAT ARE RELEVANT TO THE POSITION
EMPLOYMENT RECORD: Starting with your present post, list in REVERSE ORDER every employment you have had. Use a separate block for each post. Note
any period during which you were not gainfully employed. If you need more space, attach additional pages of the same size.
A. PRESENT POST (LAST POST, IF NOT PRESENTLY IN EMPLOYMENT)
FROM TO CURRENT SALARY PER ANNUM (in USD) EXACT TITLE OF YOUR
POST
CURRENT GROSS NET
NAME OF EMPLOYER TYPE OF BUSINESS EMPLOYMENT TYPE
FULL TIME ☐ PART TIME ☐ __%
ADDRESS OF EMPLOYER NAME OF SUPERVISOR
TITLE OF SUPERVISOR
EMAIL ADDRESS AND TELEPHONE NO. OF SUPERVISOR
NO. AND KIND OF EMPLOYEES REASON FOR LEAVING
SUPERVISED BY YOU
DESCRIPTION OF YOUR DUTIES / KEY ACHIEVEMENTS
B. PREVIOUS POSTS (IN REVERSE ORDER)
FROM TO SALARY PER ANNUM (in USD) EXACT TITLE OF YOUR POST:
GROSS NET
NAME OF EMPLOYER: TYPE OF BUSINESS EMPLOYMENT TYPE
FULL TIME ☐ PART TIME ☐ __%
ADDRESS OF EMPLOYER: NAME OF SUPERVISOR
TITLE OF SUPERVISOR
EMAIL ADDRESS AND TELEPHONE NO. OF SUPERVISOR
NO. AND KIND OF EMPLOYEES REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES / KEY ACHIEVEMENTS
FROM TO SALARY PER ANNUM (in USD) EXACT TITLE OF YOUR POST:
GROSS NET
NAME OF EMPLOYER: TYPE OF BUSINESS EMPLOYMENT TYPE
FULL TIME ☐ PART TIME ☐ __%
ADDRESS OF EMPLOYER: NAME OF SUPERVISOR
TITLE OF SUPERVISOR
EMAIL ADDRESS AND TELEPHONE NO. OF SUPERVISOR
NO. AND KIND OF EMPLOYEES REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES / KEY ACHIEVEMENTS
FROM TO SALARY PER ANNUM (in USD) EXACT TITLE OF YOUR POST:
GROSS NET
NAME OF EMPLOYER: TYPE OF BUSINESS EMPLOYMENT TYPE
FULL TIME ☐ PART TIME ☐ __%
ADDRESS OF EMPLOYER: NAME OF SUPERVISOR
TITLE OF SUPERVISOR
EMAIL ADDRESS AND TELEPHONE NO. OF SUPERVISOR
NO. AND KIND OF EMPLOYEES REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES / KEY ACHIEVEMENTS
FROM TO SALARY PER ANNUM (in USD) EXACT TITLE OF YOUR POST:
GROSS NET
NAME OF EMPLOYER: TYPE OF BUSINESS EMPLOYMENT TYPE
FULL TIME ☐ PART TIME ☐ __%
ADDRESS OF EMPLOYER: NAME OF SUPERVISOR
TITLE OF SUPERVISOR
EMAIL ADDRESS AND TELEPHONE NO. OF SUPERVISOR
NO. AND KIND OF EMPLOYEES REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES / KEY ACHIEVEMENTS
FROM TO SALARY PER ANNUM (in USD) EXACT TITLE OF YOUR POST:
MONTH/YEAR MONTH/YEAR GROSS NET
NAME OF EMPLOYER: TYPE OF BUSINESS EMPLOYMENT TYPE
FULL TIME ☐ PART TIME ☐ __%
ADDRESS OF EMPLOYER: NAME OF SUPERVISOR
TITLE OF SUPERVISOR
EMAIL ADDRESS AND TELEPHONE NO. OF SUPERVISOR
NO. AND KIND OF EMPLOYEES REASON FOR LEAVING:
SUPERVISED BY YOU:
DESCRIPTION OF YOUR DUTIES / KEY ACHIEVEMENTS
HAVE YOU ANY OBJECTIONS TO OUR MAKING INQUIRIES OF YOUR PRESENT EMPLOYER? YES/NO
ARE YOU NOW OR HAVE YOU EVER BEEN A CIVIL SERVANT IN YOUR GOVERNMENT’S EMPLOY? YES/NO
If answer is “yes”, WHEN?
REFERENCES: List three persons, not related to you who are familiar with your character and qualifications.
Do not repeat names of supervisors listed before.
FULL NAME FULL ADDRESS; INCLUDING E-MAIL NAME OF ORGANIZATION,
ADDRESS AND TELEPHONE NUMBER BUSINESS OR OCCUPATION
STATE ANY OTHER RELEVANT FACTS
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 of each case in an attached statement.
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 an Application Form or other document requested by
IRENA renders me liable to termination or dismissal.
DATE (day, month, year) 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 IRENA.
