INSTRUCTIONS
Please answer each question clearly and completely.  Type or print in ink.  Read carefully and follow all directions.
UN Number (UN HQ use only)
UNITED   NATIONS
Peacekeeping Mission Headquarters On Call List
NOMINATION & PERSONAL HISTORY FORM 
Passport Size Photo
1. Family name  First name Middle name  Rank
2.  Dateof Birth Day
Mo.
Yr. 
 3. Place of birth 
4. Nationality (ies) at birth 
5. Present nationality (ies)
 6. Sex
7. Height 8. Weight .
9. Are their any restrictions on your employment?                YES 0     NO 0              If “yes”, please describe.
10. Are you medically and dentally fit to deploy worldwide?  YES 0     NO 0.
11. Do you possess a valid drivers license?                            YES 0     NO 0.
12. Present Contact Details  . .
Address . .
Telephone No. Fax E-mail
13. Permanent Mission Contact in New York . .
Address . .
Telephone No. Fax  Email
14. What Positions on the On Call List are you nominating for? (indicate Serial). .
15. KNOWLEDGE OF LANGUAGES.  What is your mother tongue?
.
READ
READ
WRITE
WRITE
SPEAK
SPEAK
UNDERSTAND
UNDERSTAND
.
.
Not
.
Not
.
Not
.
Not
OTHER LANGUAGES
Easily
Easily
Easily 
Easily
Easily
Easily
Easily 
Easily 
. . . . . . . . .
. . . . . . . . .
. . . . . . . . .
. . . . . . . . .
16. Military Education and Training Completed.
COURSE, PLACE AND COUNTRY
ATTENDED FROM/TO
QUALIFICATIONS OBTAINED
. Mo./Year .
. . .
. . .
. . .
. . .
. . .
17. EMPLOYMENT RECORD: Starting with your present post, list in reverse order every posting you have had.  Use a separate block for each post. If you need more space, attach additional pages of the same size.
A. PRESENT POST (LAST POST, IF NOT PRESENTLY IN EMPLOYMENT)
FROM
TO
 . . EXACT TITLE OF YOUR POST AND RANK:
MONTH/YEAR
MONTH/YEAR
 . . .
. . . . .
TYPE OF UNIT/HQ: .
. .
DESCRIPTION OF YOUR DUTIES
.
.
B. PREVIOUS POSTS (IN REVERSE ORDER)
FROM
 TO
 . . EXACT TITLE OF YOUR POST AND RANK:
MONTH/YEAR
MONTH/YEAR
 . . .
. . . . .
TYPE OF UNIT/HQ: .
. .
DESCRIPTION OF YOUR DUTIES
.
.
.
.
FROM
TO
.
.
EXACT TITLE OF YOUR POST AND RANK:
MONTH/YEAR
MONTH/YEAR
 . . .
. . . . .
TYPE OF UNIT/HQ: .
. .
DESCRIPTION OF YOUR DUTIES
.
.
.
.
18. STATE ANY OTHER RELEVANT FACTS
19.  HAVE YOUR 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 0                 NO 0
If “yes”, give full particulars of each case in an attached statement.
20. 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 a Personal History form or other document requested by the Organization renders me liable for removal from the list or repatriation.
 

 DATE: -------------------------                                  SIGNATURE :------------------------------------------------
21. FOR REPRESENTATIVE OF PERMANENT MISSION IN NEW YORKCan it be guaranteed that the individual be provided for service worldwide on the degree of notice indicated below, regardless of mission area or type of mission?  YES 0     NO 0.At what degree of notice can the individual be ready for embarkation for a mission?  7 days 0     14 days 0.If there are any known restrictions on employment, such as mission area or type of mission, what are they?
 

 DATE: --------------------------                                 SIGNATURE :-------------------------------------------------
                                                                                     NAME :          -------------------------------------------------