PROFESSIONAL

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
E-MAIL

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 Qualification

WORKING 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. / NGO
5. / 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 reform
Children/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 education
Education 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 testing
Urban 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-person
Report 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 networks
Database 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 assessment
Others

SSA Registration Form-2008Revised 22/08/2007

Past Work Experience of 10 years (Start from most recent)

Employer: / Post: / Supervisor’s Name / Duration
From: / 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 / Duration
From: / 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:
E-Mail
Assignment Dates: / From: / To:
2. / Project/Employer:
Address:
Contact Person: / Telephone No:
E-Mail
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