REGISTER MEMBERSHIP APPLICATION FORM

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> REGISTER MEMBERSHIP APPLICATION FORM  RedR India B3 Loknath Apts, 106 Mayur Colony, off Karvey Rd. Pune, India-411029

Tel:  +91-20-25467566

Fax: +91-20-5431430

Email: info@redrindia.org

  Office use only

Date received:

Approved by:

Refs requested:

Interview:     [ Y ]     [ N ]

Area of specialisation:

Additional check?

Notes

Please attach a passport sized photo   Please use the Guidance Notes provided for the relevant sections  Personal Information       Family Name   First

Name

  Known as:

(if different)

    Nationality   Sex       Date of Birth   Age     Mailing Address   Home Address if different to mailing   Employer  and Address                       Country     Country     Country             Tel     Tel     Tel   Mobile     Mobile     Mobile   Fax     Fax     Fax   E-mail     E-mail     E-mail  

    Next of Kin

(details of two people at different addresses to ensure reliability of contact)        

Dependents

                              Country     Country     Tel     Tel     Email     Email     Relationship     Relationship       Closest Interview Centre Pune 00/font>                              North India00/font>                               East India  00/font> 

South India               00/font>                              Nepal    00/font>                               Dhaka00/font>    Columbo00/font> 

Refer to website for forthcoming interview locations

Have you applied to another RedR register?  No  00/font>     Yes    00/font> If yes, which one?00000000000000000  How did you hear of RedR ?

If through a website or an article etc, please state which one.

    Motivations for applying to the RedR register                    Professional background Qualifications   Academic after secondary/high school Professional (membership of institutions etc.):                        Training Please give details of training courses which are directly relevant to humanitarian work Name of course Dates Organisation                                        Professional Experience. Please give a brief description of your key professional experience to date, writing your most recent experience last.  Although you have been asked to supply a copy of your CV, do not write please refer to CV. Please write most recent experience last. Country Dates (include months) Position/Responsibilities Organisation                                                                                                                                    Character Profile (See Guidance Notes)                Competency Profile (see Guidance Notes) Functional Competencies       Skill area Self assessment No. of years experience Areas of Specialisation Interviewer00

Ranking (0-5)

Accountancy / Finance         Administration / Office Management         Advocacy/Rights/Gender Specialists         Civil / Construction / Building         Community Mobilisation         Electricity Supply         Environmental Management         Food Security/Agronomy/Agriculture         Information / PR / Media         Information Technology         Institutional & Organisational Development         Logistics         Mechanical Plant         Mechanical/Building Services Engineering         Mine Clearance/UXO Clearance         Needs Assessment         Personnel Management         Radio Telecommunication         Roads, Airstrips and Bridges         Sanitation         Security         Training and Development         Water Sources         Water Supply                       Core Competencies and Skills (see Guidance Notes)     Management and Supervision Experience Self Assessment Language Skills

(include mother tongue)

Self Assessment Team Supervision       Project  Management       Programme Management                             Computing skills Self Assessment Principal software packages used in category Word processing     Spreadsheet     Database     Email and internet     Accounting     Geographical Information Systems/Mapping     Computer Aided Design and Draughting                          Medical Information During the last 10 years have you suffered any significant medical illnesses, which may affect your ability to go on

assignment?

Yes 00/font> No 00/font> If yes please provide details     Are you mentally and physically fit for arduous conditions? Yes 00/font> No 00/font> If not please provide details         Availability for Assignment Would there be any restrictions/conditions on your availability? Yes 00/font> No 00/font> If yes, please provide details     Indicate any countries you cannot or will not work in, giving reasons       Indicate any agencies for whom you will not work     Some relief agencies pay very little, do you have minimum salary requirements? Yes 00/font> No 00/font>   If so what is it:                  

per annum

Please indicate your likely availability for assignment in the future as follows. Are you currently available? Yes 00/font> No 00/font> If so what is the maximum duration of assignments you would currently consider?    3 Months 00/font>    6 Months 00/font>   12 Months 00/font> If not when will you be?       Referees Work colleague   Employer/Manager             Country     Country   Tel     Tel   Fax     Fax   Email     Email   Relationship     Relationship    Signature To the best of my knowledge the information given in this application form is correct.

(If applying by email, please type signature, you will be asked to sign at a later date.)

Signature:    Date:    

Please return this form and a copy of your CV in the recommended format to

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