Personal details	Family name:
	Maiden name (if applicable):
	Forename(s):
	Date of birth:
	Place of birth:	Town:
		Country:
	Current nationality:	Acquired by:

Mailing address	No. & Street:
	Zip/Post code:
	Town:
	Country:
	Telephone:
	Mobile:
	FAX:	Email:

Preferred internship assignment/In ternship Description	A. To facilitate placement, please indicate in order of priority (maximum 3) the preferred areas of activities for which you wish to be considered for internship based on your educational background and interests.
	Conferences Finance General Services Human Resources Information Technology International Partnerships and Development Research and Innovation Secretariat Strategic Planning and Policy Training Translation International marketing Logistics /Procurement
	B. Briefly describe what you plan do during the internship placement ( your role and responsibilities)

	C. Briefly describe the relationship between your academic program and preparation ( e.g., courses taken , extracurricular projects pursued, etc.) and the paraprofessional experience to be provided by the internship placement:

Payment Issue	D. Indicate if you would prefer paid Internship?
	Yes No
	E. What is the possible minimum amount you would accept ?

	F. In case a company would offer you the training placement without payment would you consider such?
	Yes No

Dates proposed for the Internship	From: (month/year)
	To: (month/year)
	Compulsory internship : Yes No

Indicate the reasons of your choice

Education	Give full details in reverse chronological order (starting from the latest). Give the exact name of the institution and title of degree in the original language. Do not include primary/secondary school if you have a university degree or equivalent.
	Years	Institution (name, place)	Degree obtained	Main field(s) of study

Language skills

Mother tongue:

For languages other than mother tongue, enter appropriate letter from coding below to indicate the level of your knowledge.

A- Professional Fluency: Able to converse actively at high level of fluency and prepare reports and papers
B- Working Knowledge: Able to follow work-related discussions, use the telephone, and understand documents-grammar may be uncertain.
C- Limited Knowledge: Able to understand simple conversations and written texts.

Language	Understand	Speak	Read	Write
French
English
Spanish
Arabic

Computer Skills	For computer skills please check the box.
	Word processing:	Graphics/Image/Photo software:
	Spreadsheets:	Financial software:
	Data bases:	Web browser /E-mail:
	Presentation software:	Other (s)software (Please specify below):
	Please explain your proficiency in your computer skills:

Professional experience	List positions held in reverse order, (starting with the current/latest one):
	Date:	From: To:
	Job title:
	Employer:	Name:
		Address:
		Tel: Fax:
		Email:
	Description of your duties and responsibilities:


	Date:	From: To:
	Job title:
	Employer:	Name:
		Address:
		Tel: Fax:
		Email:
	Description of your duties and responsibilities:

Academic achievements	Please indicate any academic published works and other recognized achievements and/or any previous practical experience you may have, giving details of your duties.

Medical Self Declaration

Do you have any physical disability or condition which may need taking into consideration in the workplace?

Yes No If "yes", please give full particulars

Insurance	I hereby confirm that my application will be endorsed by my educational institution through a Memorandum of understanding which includes a health and accident insurance
	or
	I hereby confirm I hold an accident and health insurance policy
	Company Name (accident):
	Company Address (accident):
	Company Name (Health):
	Company Address (Health):

References	Optional : List persons not related to you, who are familiar with your character and qualifications
	I°/
	Name:
	Occupation/ Business, Title:
	Contact details:
	II°/
	Name:
	Occupation/ Business, Title:
	Contact details:
	III°/
	Name:
	Occupation/ Business, Title:
	Contact details:

Potential Issues	Are you exercising/ have already exercised an offense that may be incompatible with an Internship within any establishment ?
	Yes No If "yes", please give full particulars

A non-refundable administrative/ processing fee of 50EURS must be paid in advance. The additional admin fee of 50EURS is applicable if and only when the application is successful. Some of the activities and correspondences are jointly carried out with you the applicant.

I certify that my answers to the above questions are true, complete and correct to the best of my knowledge and belief.

Date:

Signature: