APPLICATION FORM FOR EMPLOYMENT WITH
THE
U.S.
MISSION, NEW DELHI, INDIA
NAME
IN FULL
(Last) (First) (Middle) |
JOB TITLE IN
ANNOUNCEMENT |
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SEX Male : Female: |
ANNOUNCEMENT
NO. |
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PRESENT
ADDRESS AND TELEPHONE NO. |
DATE OF
BIRTH
(Month, Day, Year) |
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PLACE OF
BIRTH
(City, Country) |
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CITIZENSHIP |
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NAMES AND
LOCATION OF EDUCATIONAL INSTITUTIONS ATTENDED |
DATES
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DEGREE
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MAJOR
SUBJECTS
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From |
To |
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COMPUTER
EXPERIENCE:
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SPECIAL QUALIFICATIONS AND SKILLS: List any special skills you possess, i.e. machines, equipment. |
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TYPING
SKILLS _______________WPM |
LICENSES/CERTIFICATION: |
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LANGUAGE
PROFICIENCY (Level of competence) Level I : Rudimentary Level III : Good
Working Knowledge Level V : Interpreter Level II : Limited
Knowledge Level IV : Fluency |
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Language |
Speak |
Read |
Write |
Understand |
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EMPLOYMENT: Your previous 5 positions of employment. May we approach your present employer? Yes No |
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Dates of
Employment From: To: |
Title of
Position |
Duties
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Salary (Per
Year) |
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Name
and Address of Employer
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Name,
Title and phone number of Immediate Supervisor
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Reason
for Leaving
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Dates of
Employment From: To: |
Title of
Position |
Duties
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Salary (Per
Year) |
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Name
and Address of Employer
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Name,
Title and phone number of Immediate Supervisor
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Reason
for Leaving
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Dates of
Employment From: To: |
Title of
Position |
Duties
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Salary (Per
Year) |
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Name
and Address of Employer
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Name,
Title and phone number of Immediate Supervisor
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Reason
for Leaving
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Dates of
Employment From: To: |
Title of
Position |
Duties
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Salary (Per
Year) |
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Name
and Address of Employer
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Name,
Title and phone number of Immediate Supervisor
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Reason
for Leaving
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Dates of
Employment From: To: |
Title of
Position |
Duties
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Salary (Per
Year) |
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Name
and Address of Employer
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Name,
Title and phone number of Immediate Supervisor
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Reason
for Leaving
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REMARKS |
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LIST
ANY RELATIVES OR FAMILY MEMBERS EMPLOYED BY THE U.S. MISSION |
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Name |
Section |
Relationship |
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CERTIFICATION
Before
signing this form make sure you have answered all questions fully and
completely. A false
statement on this form is cause for disqualification/dismissal. |
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I
do solemnly affirm that the information contained herein is correct to the
best of my knowledge and belief. ______________________________________
_____________ SIGNATURE
DATE |
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Form HR-01;
05/04