UNICEF LOCAL CONSULTANT ROSTER REGISTRATION FORM
REGISTRATION NO. / REGISTRATION DATED / REGISTRATION UPDATE(To be filled in by UNICEF)
PERSONAL INFORMATION
(To be filled in by the Applicant/Candidate in Block Letters)
TITLE
(Mr. / Ms. / Dr.)FULL NAME
LAST NAME / FIRST NAME
Date of Birth:Place of Birth:
ADDRESS(Office)ADDRESS(Residence)
ORGANIZATION
(if applicable)
TELEPHONE / Office / Cell:Residence
QUALIFICATION
Specify the highest education level achieved (e.g. BA / B.Com / B.Sc / BSS / B.Agr / B.Engr / MA / M.Com / MSS / M.Sc / MBA / MBBS /
Ph.D / Post Doctoral etc)
Applicable QualificationWORKING LANGUAGES
(English, Bangla, French, Other)
1. / English / 2. / 3. / 4.PROFESSIONAL EXPERIENCE WITH
(Tick on the applicable box/boxes)
1. / Govt. / 2. / Public Sector / 3. / Private Sector / 4. / NGO5. / Academic/Research / 6. / International
Donor Agency / 7. / UN / 8. / Other (Please Specify)
MAIN SECTORS OF SPECIALIZATION MINIMUM 10 (ten) YEARS PROGRESSIVE WORK EXPERIENCE
SSA Registration Form-2008Revised 14/01/2008
(Choose Main Sectors of Expertise and put tick mark on the applicable box/boxes. These must be substantiated by your CV)
SSA Registration Form-2008Revised 14/01/2008
Child Protection
SSA Registration Form-2008Revised 14/01/2008
Juvenile justice system and legal reformChildren/Adolescents participation
Proactive social work (international
Psychosocial care/rehabilitation
Life skills (local & international)
CSEC issues and integration methodology
Livelihood (local and international)
Interactive Communication program development
Others
Education
Education Governance, quality improvement at school and local level in primary educationEducation Planning, Policy & Development
Teacher Development and Training
Expert in package development for "better health better education"
Expert on various areas of inclusive education
Life-skills development for Primary & Secondary School with particular focus on curriculum matgerials
Education Management Information System
Early Learning Development including competencies
Advocacy and Communication Strategy Development
Expert on Non Formal Education
Expert on Life Skill Training
Expert in MER(specifically on baseline, trace and track system; social mobilization);
Others
Water & Environmental Sanitation
Water and sanitation engineering,(low cost community-based technologies)Water supply, human waste disposal, solid waste disposal, drainage, ecological options, water resources,
Water treatment, water quality testingUrban Planning Water supply and Sanitation
Waster Disposal systems in Urban/Rural settings
Community development with emphasis on participatory methods and hygiene promotion
Communication specialists, both mass media and person-to-person
Institutional capacity building specialist including design of training programmes
Poverty specialists
Gender specialists
Policy specialists – including economic analysis, aid modalities (SWAPs, PRSPs, MTEFs), water sector
Specific policy issues
Workshop planners and facilitators
M&E specialists, including design or surveys and studies
Emergency experience in working with WES
Others
Communication
Communication specialists, both mass media and person-to-personReport writers and translators
Others
Health & Nutrition
Production Nutritionist, expert in promoting household production of nutritious food (agriculture/livestock)HIV/AIDS Prevention, Community Support System
Food Fortification
Newborn care
Others
Information & Communication Technology
Design of data communication networksDatabase development and management
VSAT installation
Radio telecommunication networks: design, implementation and support
Help desk and End user support
Infrastructure support
Installation and Support of electronic security systems
Business application support
Management information systems
Management of electronic records and knowledgebase systems
Others
General
Gender Awareness
Programme Communication
HIV/AIDS
Emergency planning, implementation and monitoring with knowledge of emergency need assessmentOthers
SSA Registration Form-2008Revised 22/08/2007
Past Work Experience of 10 years (Start from most recent)
Employer: / Post: / Supervisor’s Name / DurationFrom: / To:
Main 5 Job Responsibilities
Employer: / Post: / Supervisor’s Name / Duration
From: / To:
Main 5 Job Responsibilities
Employer: / Post: / Supervisor’s Name / Duration
From: / To:
Main 5 Job Responsibilities
SSA Registration Form-2008Revised 22/08/2007
Employer: / Post: / Supervisor’s Name / DurationFrom: / To:
Main 5 Job Responsibilities
SSA Registration Form-2008Revised 22/08/2007
REFERENCE
(List your two most recent work related references relevant to the information you have given)
1. / Project/Employer:Address:
Contact Person: / Telephone No:
Assignment Dates: / From: / To:
2. / Project/Employer:
Address:
Contact Person: / Telephone No:
Assignment Dates: / From / To:
WOULD YOU BE WILLING TO SHARE THIS INFORMATION WITH OTHER UN PROJECTS AND OTHER INTERNATIONAL DEVELOPMENT AGENCIES?
YES / NO(Attach CV in electronic format in MS-Word)
On completion please return the form and your C.V to(Expertising area must be mentioned in the subject line)SSA Registration Form-2008Revised 22/08/2007