INDIVIDUAL CONSULTANT PROCUREMENT NOTICE. Project Implementation Support Consultant (For Sudanese Nationals Only)

Transcription

1 INDIVIDUAL CONSULTANT PROCUREMENT NOTICE Date: 13 th July, 2016 Consultant: Location: Type of Contract: Language required: Project Implementation Support Consultant (For Sudanese Nationals Only) Khartoum, Sudan, with frequent travels to the field Individual Contract English, Arabic Duration of initial Contract: 12 months Positions: THREE (Located at Federal Ministry of Health in Khartoum, Communicable and Non Communicable Disease Control Department with frequent visits to UNDP GF Office) Offers should be submitted physically to: United Nations Development Programme (UNDP) Global Fund Programme Management Unit UNDP Compound, House 7, Block 5, Gama a Avenue, P O BOX: 913 Khartoum, Sudan, Reference: PN/KRT/GF/16/13 Or submitted electronically in PDF format ONLY to procurement.gf.sd@undp.org no later than Sunday 24 th July, 2016 ( subject title should be Project Implementation Support consultant ) Any request for clarification must be sent in writing, or by standard electronic communication to the address: bid.queries.gfatm@undp.org. UNDP will send written copies of the response, including an explanation of the query without identifying the source of inquiry, to all contractors. 1. BACKGROUND UNDP is key partner to the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) and is the UN agency assuming the role of Principal Recipient for Global Fund grants in Sudan. In the role of Principal Recipient, UNDP is responsible for the financial and programme management of the Global Fund grants as well as procurement of pharmaceutical, non-health items and required services. In all areas of implementation, UNDP provides support to relevant institutions, sub-

2 recipients and implementing partners to ensure the timely and effective execution of the Global Fund programs. In line with the ongoing integration process, the Federal Ministry of Health (FMOH) has formed the Communicable and Non-Communicable Diseases Control Directorate (C&NCDC) under the Primary Health Care Department in The C&NC DC will lead the management and coordination of TB, HIV and Malaria grants. All functionalities are extracted from the previously vertical programmes, merged, integrated with existing structure to ensure harmonization in planning, implementation and monitoring of activities supported by GFATM. This includes case management, monitoring and evaluation, supply chain and financial management. C&NCDC will continue to be the main SRs implementing the TB, HIV and Malaria grant activities in Sudan ensuring proper service delivery at all levels, health strategic information supporting the implementation of surveys and surveillance and capacity building of the health workforce. Additionally, C&NC DC will be offering Technical Assistance in several clinical and monitoring and evaluation activities. It will also be in charge of managing the funds to support the running costs for health facilities and staff compensations. The Project Implementation Support (PIS) Consultant is expected to facilitate the execution of project tasks and support FMoH, C&NCDC team to ensure timely and effective implementation of this project. 2. SCOPE OF WORK, RESPONSIBILITIES AND DESCRIPTION OF THE PROPOSED ANALYTICAL WORK Under the direct supervision of the Director of Communicable and Non Communicable Disease Control Department, CNCDCD at FMOH and the Deputy Programme Manager, GF PMU, UNDP and in coordination with the respective grant managers and FMoH departments, the Consultant ensures the timely implementation of the global Fund funded projects signed between UNDP and the Federal Ministry of Health. The Consultant will be based in the CNCDCD at Ministry of Health in Khartoum and provides the following services: Organize, facilitate and oversee implementation of the different components of the global fund project activities signed between the Ministry of Health, CNCDCD and UNDP; In consultation with respective CNCDCD and FMoH departments and states; ensure the development of an acceleration plan for implementation of the global fund project activities; As part of CNCDCD team, organize and facilitate multiple trainings, meetings, events as set out the Global Fund project document and sub- recipient agreement between UNDP and CNCDCD for TB, HIV and Malaria grants; Ensure all activities of the Global Fund project document and sub- recipient agreement between UNDP and CNCDCD are implemented, documented and timely reported to concerned entities; In consultation and collaboration with CNCDCD, UNDP and implementing departments, facilitate the monthly implementation meeting to review project implementation status; bottlenecks and jointly come up with remedial actions to realize the implementation of set out activities;

3 Support the CNCDCD and FMoH team in the preparation, analysis and development of quarterly programmatic and financial reporting to different concerned entities including UNDP; Support in planning, organizing and ensure the distribution of medical equipment, facilitate communications within the Ministry, States and health facilities; Actively engage in field project monitoring activities. The consultants shall be available to travel to field locations to review the project implementation status. Work with CNCDCD and FMoH finance team to facilitate the timely liquidation of advanced funds and follow up on compilation of supporting documentations as set out in the project agreement between the Ministry of Health and UNDP; Any other assignment or tasks set by the CNCDCD Director, UNDP Deputy Programme Manager as appropriate. Deliverables 1- Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. 2- Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 3. REQUIREMENTS FOR EXPERIENCE AND QUALIFICATIONS I. Education: Master s degree in Business, Economics, Public Administration, public health or any development related field. II. Years of experience: Minimum of 3 years professional experience in implementation of public health programmes with focus on HIV/AIDs, Tuberculosis and Malaria, monitoring and evaluation, project management, preferably working in health care settings; Previous experience of working with Ministry of Health at Federal or State level or other key health partners. III. Competencies: Corporate Competencies: Demonstrates commitment to UNDP s mission, vision and values. Exerts strict adherence to corporate rules, regulations and procedures. Functional Competencies: Knowledge Management and Learning Shares knowledge and experience. Development and Operational Effectiveness Ability to perform specialized tasks related to Results-Based Management, including support to design, planning and implementation of programme, managing data & reporting.

4 Ability to establish and maintain contacts with senior-level officials of the host government required. Excellent interpersonal skills are essential part of the job. Excellent analytical and strong communication skills both written and spoken Leadership and Self-Management Focuses on result for the client and responds positively to feedback. Consistently approaches work with energy and a positive, constructive attitude. Remains calm, in control and good humored even under pressure, Demonstrates openness to change and ability to manage complexities. IV. Language required English and Arabic language fluency and strong writing skills required. 4. DOCUMENTS TO BE INCLUDED WHEN SUBMITTING THE PROPOSALS. Interested individual consultants must submit the following documents/information to demonstrate their qualifications: 1.Proposal: (I) Explaining why they are the most suitable for the work (ii) Provide a brief methodology on how they will approach and conduct the work 2. Financial proposal 3. Personal CV including past experience in similar projects and at least 3 references 4. Offeror s letter to UNDP confirming interest and availability for the individual contractor (IC) assignment. 5. FINANCIAL PROPOSAL Lump sum contracts The financial proposal shall specify a total lump sum amount, and payment terms around specific and measurable (qualitative and quantitative) deliverables (i.e. whether payments fall in installments or upon completion of the entire contract). Payments are based upon output, i.e. upon delivery of the services specified in the TOR. In order to assist the requesting unit in the comparison of financial proposals, the financial proposal will include a breakdown of this lump sum amount (including travel, per diems, and number of anticipated working days). 6. EVALUATION The offers received from the candidates will be evaluated using combined scoring method. The combined scoring method assesses the offers with technical merits of the proposals where the qualifications and methodology will be weighted a max. Of 70%, and later combined with the price offer which will be weighted a max of 30%.

5 Individual consultants will be evaluated based on the following methodology: Lowest price and technically compliant offer When using this method, the award of a contract should be made to the individual consultant whose offer has been evaluated and determined as both: a) responsive/compliant/acceptable, and b) offering the lowest price/cost responsive/compliant/acceptable can be defined as fully meeting the TOR provided. The lowest priced bid from among the technically qualified Offerors will obtain the full marks of 30 points in the price proposal. Price proposals of remaining qualified bidders will be prorated against the lowest priced bid using the following formula to derive the marks in their price proposal: Marks obtained by a Bidder = Lowest Priced Bid (amount) / Bid of the Offeror (amount) X 30 (Full Marks) Only candidates obtaining a minimum of 49 point would be considered for the Financial Evaluation Evaluation Grid Weight Total Obtainable Marks A. Technical Evaluation Criteria (70 Points, Pass Marks 49): 70% Years of working experience in designing and implementing project especially in the areas of HIV/AIDS, TB and Malaria or similar public health programmes. 2- Specialist with university degree in social science, public health or other relevant fields. 3- Specialized / certified training in public health or programme management or monitoring and evaluation. 20% % % Demonstrated understanding of the ToR, particularly the scope of works and deliverables as described in the offer/proposal 15% 150 SUB TOTAL (A) 70% 700 B. Financial Proposal 30% 300 Financial Proposal (Please refer to the Breakdown of Cost Template enclosed in the bidding document under Offeror s Letter to UNDP for detailed preparation of Financial Proposal Table A & B in ANNEX 2) SUB TOTAL (B) 30% 300 GRAND TOTAL (A+B) 100% 1,000 ANNEXES: ANNEX 1 TERMS OF REFERENCES (TOR) ANNEX 2 OFFERORs LETTER fully filled including Table A & B of breakdown costs. ANNEX 3 P11 FORM ANNEX 4 INDIVIDUAL CONSULTANT GENERAL TERMS AND CONDITIONS.

6 Terms of Reference (TOR) Annex 1 For an assignment requiring the services of an Individual Contract (IC) to facilitate the implementation of project tasks and provide support to MoH team ensuring timely and effective implementation of this project. A. Project Title: HEALTH SYSTEM STRENGTHENING B. Organizational Context: UNDP is key partner to the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) and is the UN agency assuming the role of Principal Recipient for Global Fund grants in Sudan. In the role of Principal Recipient, UNDP is responsible for the financial and programme management of the Global Fund grants as well as procurement of pharmaceutical, non-health items and required services. In all areas of implementation, UNDP provides support to relevant institutions, sub-recipients and implementing partners to ensure the timely and effective execution of the Global Fund programs. In line with the ongoing integration process, the Federal Ministry of Health (FMOH) has formed the Communicable and Non-Communicable Diseases Control Directorate (C&NCDC) under the Primary Health Care Department in The C&NC DC will lead the management and coordination of TB, HIV and Malaria grants. All functionalities are extracted from the previously vertical programmes, merged, integrated with existing structure to ensure harmonization in planning, implementation and monitoring of activities supported by GFATM. This includes case management, monitoring and evaluation, supply chain and financial management. C&NCDC will continue to be the main SRs implementing the TB, HIV and Malaria grant activities in Sudan ensuring proper service delivery at all levels, health strategic information supporting the implementation of surveys and surveillance and capacity building of the health workforce. Additionally, C&NC DC will be offering Technical Assistance in several clinical and monitoring and evaluation activities. It will also be in charge of managing the funds to support the running costs for health facilities and staff compensations. The Project Implementation Support (PIS) Consultant is expected to facilitate the execution of project tasks and support FMoH, C&NCDC team to ensure timely and effective implementation of this project. C. Functions / Key Results Expected: Under the direct supervision of the Deputy Programme Manager in consultation with grant managers of HIV, TB, Malaria and HSS, and in coordination with the MoH departments, the Consultant ensures the timely implementation of the projects signed between UNDP and the Ministry of Health. The Consultant will be partially based between UNDP and the Ministry of Health in Khartoum and provides the following services as per objectives mentioned below.

7 D. Objectives: The objectives of this consultancy are as follows: Under the direct supervision of the Director of Communicable and Non Communicable Disease Control Department, CNCDCD at FMOH and the Deputy Programme Manager, GF PMU, UNDP and in coordination with the respective grant managers and FMoH departments, the Consultant ensures the timely implementation of the global Fund funded projects signed between UNDP and the Federal Ministry of Health. The Consultant will be based in the CNCDCD at Ministry of Health in Khartoum and provides the following services: Organize, facilitate and oversee implementation of the different components of the global fund project activities signed between the Ministry of Health, CNCDCD and UNDP; In consultation with respective CNCDCD and FMoH departments and states; ensure the development of an acceleration plan for implementation of the global fund project activities; As part of CNCDCD team, organize and facilitate multiple trainings, meetings, events as set out the Global Fund project document and sub- recipient agreement between UNDP and CNCDCD for TB, HIV and Malaria grants; Ensure all activities of the Global Fund project document and sub- recipient agreement between UNDP and CNCDCD are implemented, documented and timely reported to concerned entities; In consultation and collaboration with CNCDCD, UNDP and implementing departments, facilitate the monthly implementation meeting to review project implementation status; bottlenecks and jointly come up with remedial actions to realize the implementation of set out activities; Support the CNCDCD and FMoH team in the preparation, analysis and development of quarterly programmatic and financial reporting to different concerned entities including UNDP; Support in planning, organizing and ensure the distribution of medical equipment, facilitate communications within the Ministry, States and health facilities; Actively engage in field project monitoring activities. The consultants shall be available to travel to field locations to review the project implementation status. Work with CNCDCD and FMoH finance team to facilitate the timely liquidation of advanced funds and follow up on compilation of supporting documentations as set out in the project agreement between the Ministry of Health and UNDP; Any other assignment or tasks set by the CNCDCD Director, UNDP Deputy Programme Manager as appropriate. E. Specific Objectives: Acceleration of the implementation of the TB, HIV/AIDS and Malaria grants. Quality and timely implementation of various interventions in the TB, HIV/AIDS and Malaria grants. Adequate documentation and reporting of TB, HIV/AIDS and Malaria grants. F. Expected Outputs and Deliverables The consultant is expected to produce the following deliverables, with in the below mentioned tentative timeframe:

8 No Deliverables/ Outputs Estimated Duration to Complete Target Dates Due Cumulative % of Payment Review and Approvals Required 1 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 2 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 3 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 4 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities 30 days Within 30 days from contract commencement 30 days Within 60 days from the Contract commencement 30 days Within 90 days from the contract commencement 30 days Within 120 days from the contract commencement 8 Deputy Programme Manager 8 Deputy Programme Manager 8 Deputy Programme Manager 8 Deputy Programme Manager

9 implemented and the outputs within the defined period. 5 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 6 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 7 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 8 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 30 days Within 150 days from the contract commencement 30 days Within 180 days from the contract commencement 30 days Within 210 days from the contract commencement 30 days Within 240 days from the contract commencement 8 Deputy Programme Manager 8 Deputy Programme Manager 8 Deputy Programme Manager 8 Deputy Programme Manager

10 9 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 10 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 11 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 12 Monthly implementation plan for the assigned GF grant set of interventions or component in consultation with CNCDCD concerned staff. Monthly progress activity report of 8-10 pages clearly stating the activities implemented and the outputs within the defined period. 30 days Within 270 days from the contract commencement 30 days Within 300 days from the contract commencement 30 days Within 330 days from the contract commencement 30 days Within 360 days from the contract commencement Total No. of Calender days 360 days Payment 100 % 8 Deputy Programme Manager 8 Deputy Programme Manager 8 Deputy Programme Manager 12 Deputy Programme Manager

11 G. Institutional Arrangement Under the direct supervision of the Director of Communicable and Non Communicable Disease Control Department, CNCDCD at FMOH and the Deputy Programme Manager, GF PMU, UNDP and in coordination with the respective grant managers and FMoH departments. The Consultant ensures the timely implementation of the global Fund funded projects signed between UNDP and the Federal Ministry of Health. H. Duration of the Work The assignment period is expected to be for 261 working days across 12 months period, which will commence immediately upon signing of the IC. The contract will be continuous engagement with 5 working days per week, aligning the work week with that of UNDP and Ministry of Health. I. Duty Station The Consultant will be based in the CNCDCD at Federal Ministry of Health in Khartoum premises in Khartoum with frequent visit to UNDP and travel to the fields. J. Qualifications of the Successful Individual Contractor I. Education: Master s degree in Business, Economics, Public Administration, public health or any development related field. II. Years of experience: Minimum of 3 years professional experience in implementation of public health programmes with focus on HIV/AIDs, Tuberculosis and Malaria, monitoring and evaluation, project management, preferably working in health care settings; Previous experience of working with Ministry of Health at Federal or State level or other key health partners. III.Competencies: Corporate Competencies: Demonstrates commitment to UNDP s mission, vision and values. Exerts strict adherence to corporate rules, regulations and procedures. Functional Competencies: Knowledge Management and Learning Shares knowledge and experience. Development and Operational Effectiveness Ability to perform specialized tasks related to Results-Based Management, including support to design, planning and implementation of programme, managing data & reporting. Ability to establish and maintain contacts with senior-level officials of the host government required.

12 Excellent interpersonal skills are essential part of the job. Excellent analytical and strong communication skills both written and spoken Leadership and Self-Management Focuses on result for the client and responds positively to feedback. Consistently approaches work with energy and a positive, constructive attitude. Remains calm, in control and good humored even under pressure, Demonstrates openness to change and ability to manage complexities. IV.Language required English and Arabic language fluency and strong writing skills required. I. Scope of Price Proposal and Schedule of Payments The consultancy fee will be determined on a lump sum basis. The lump sum amount must be all-inclusive and the contract price must be fixed regardless of changes in the cost components. Payment will be made upon completion of deliverables. (Financial offer template as per Table A & B of breakdown costs found in OFFERORs LETTER ANNEX 2) K. Recommended Presentation of Offer Applicants are kindly requested to complete and sign and submit all the following documents: a) Duly accomplished Letter of Confirmation of Interest and Availability (Offeror s letter) using the template provided ANNEX 2; b) Personal CV & P11 form, indicating all past experience from similar projects, as well as the contact details ( and telephone number) of the Candidate and at least three (3) professional references; c) Brief description of why the individual considers him/herself as the most suitable for the assignment, and a methodology, on how they will approach and complete the assignment. d) Financial Proposal that indicates the all-inclusive fixed total contract price, supported by a breakdown of costs, as per template provided in ANNEX 2.

13 ANNEX 2 OFFEROR S LETTER TO UNDP CONFIRMING INTEREST AND AVAILABILITY FOR THE INDIVIDUAL CONTRACTOR (IC) ASSIGNMENT Date Ms. Marta Ruedas Resident Representative United Nations Development Programme House 7,Block5, Gama a avenue, Khartoum Dear Sir/Madam: I hereby declare that: a) I have read, understood and hereby accept the Terms of Reference describing the duties and responsibilities of Project Implementation Support Consultant] b) I have also read, understood and hereby accept UNDP s General Conditions of Contract for the Services of the Individual Contractors; c) I hereby propose my services and I confirm my interest in performing the assignment through the submission of my Personal History Form (P11) which I have duly signed and attached hereto as Annex 1; d) In compliance with the requirements of the Terms of Reference, I hereby confirm that I am available for the entire duration of the assignment, and I shall perform the services in the manner described in my proposed approach/methodology which I have attached hereto as Annex 3 e) I hereby propose to complete the services based on the following payment rate : [pls. check the box]: A total lump sum of [state amount in words and in numbers, indicating exact currency], payable in the manner described in the Terms of Reference (ToR). f) For your evaluation, the breakdown of the abovementioned all-inclusive amount is attached hereto as Annex 2 of this document; g) I recognize that the payment of the abovementioned amounts due to me shall be based on my delivery of outputs within the timeframe specified in the TOR, which shall be subject to UNDP's review, acceptance and payment certification procedures;

14 h) This offer shall remain valid for a total period of days [minimum of 90 days] after the submission deadline; i) I confirm that I have no first degree relative (mother, father, son, daughter, spouse/partner, brother or sister) currently employed with any UN agency or office [disclose the name of the relative, the UN office employing the relative, and the relationship if, any such relationship exists]; j) If I am selected for this assignment, I shall Sign an Individual Contract with UNDP; k) I hereby confirm that [check all that applies]: At the time of this submission, I have no active Individual Contract or any form of engagement with any Business Unit of UNDP; or I am currently engaged with UNDP and/or other entities for the following work : Assignment Contract Type UNDP Business Unit / Name of Institution/Company Contract Duration Contract Amount I am also anticipating conclusion of the following work from UNDP and/or other entities for which I have submitted a proposal : Name of Assignment Contract Type Institution/ Company Contract Duration Contract Amount

15 l) I fully understand and recognize that UNDP is not bound to accept this proposal, and I also understand and accept that I shall bear all costs associated with its preparation and submission and that UNDP will in no case be responsible or liable for those costs, regardless of the conduct or outcome of the selection process. m) If you are a former staff member of the United Nations recently separated, pls. add this section to your letter: I hereby confirm that I have complied with the minimum break in service required before I can be eligible for an Individual Contract. Minimum break-in for FTA and PA contract is of 3 months. For TA it is 1 month. n) I also fully understand that, if I am engaged as an Individual Contractor, I have no expectations or entitlements whatsoever to be re-instated or re-employed as a staff member. o) I also fully understand that if my remuneration exceeds US$22,000 per contract or 6 months duration whichever comes first, I will defer my pension for the duration of contract failing which I will not claim the contract award; Full Name and Signature: Date Signed: Annexes [pls. check all that applies]: Duly signed P11 Form for IC (Must be submitted regardless); Breakdown of Costs Supporting the Final All-Inclusive Price as per Template ANNEX 2 (Must be submitted regardless); Brief Description of Approach to Work (as required by the TOR) (Must be Submitted as ToR requires); No Objection Letter and Proof of Leave without Pay in case you are an active government staff currently (if applicable); Declaration Family ties with UN Staff (if applicable); I am over the age of 62 and this assignment requires travel so I have attached the Fitness to work certificate with the proposal incurring my own cost (if applicable);

16 BREAKDOWN OF COSTS SUPPORTING THE ALL-INCLUSIVE FINANCIAL PROPOSAL A. Breakdown of Cost by Components: (** Please quote in SDG as this IC is for National Consultancy **) Cost Components I. Personnel Costs Professional Fees Communications Others (pls. specify) Unit Cost (SDG) Quantity 261 (Working days) Lump-sum Total Rate for the Contract Duration TOTAL Lump-sum Amount (All inclusive) Notes: [Normally, UNDP does not negotiate the offered price. However, if the quoted prices are unrealistically high in relation to qualification, expertise & experience of candidates as well as reasonableness of other cost components, UNDP may negotiate and reduce them against established / comparable benchmarks] B. Breakdown of Cost by Deliverables* Deliverables [listed as referred to in the TOR] Percentage of Total Price (Weight for payment) Amount (SDG) Deliverable 1: Deliverable 2: Deliverable.. Total 100% SDG. *Basis for payment tranches Note: Total Amount in Table-A above MUST match the total amount in Table-B here broken down into different trances. *****

17 ANNEX 3 INSTRUCTIONS Please answer each question clearly and completely. Type or print in ink. Read carefully and follow all directions. UNITED NATIONS DEVELOPMENT PROGRAMME PERSONAL HISTORY FORM (for Service Contracts and Individual Contracts) 1. Family Name First Name Middle name Maiden name, if any 2. Date of Birth Da Mo Yr 3. Place of Birth 4. Nationality (ies) at birth 5. Present nationality (ies) 6. Sexe 7. Height 8. Weight 9. Marital status Single Married Separated Widow Divorced 10. Permanent address 11. Present Address (if different) 12. Office Telephone No. Office Fax No. Office No. Telephone No. Fax No. Telephone No. Fax No. 13. Do you have a spouse and/or children? YES NO if the answer is "yes", give the following information: NAME Date of birth Relationship NAME Date of birth Relationship

18 14. Have you taken up any legal permanent status in any country other than that of your nationality? YES NO If the answer is "yes", which country? 15. Have you taken any legal steps towards changing your present nationality? YES NO If answer is "yes", explain fully: 16. Are any of your relatives employed by UNDP, any other UN organization or any other public international organization? YES NO If the answer is "yes", give the following information: NAME Relationship Name of International Organization 17. What is your preferred field of work? 18. KNOWLEDGE OF LANGUAGES. What is your mother tongue? READ WRITE SPEAK UNDERSTAND OTHER LANGUAGES Easily Not Easily Easily Not Easily Fluently Not Fluently Easily Not Easily

19 19. For clerical grades only Indicate speed in words per minute List any office machines or equipment you can use English French Other languages Typing Shorthand 20. EDUCATIONAL. Give full details - N.B. Please give exact titles or degree in original language. A. UNIVERSITY OR EQUIVALENT Please do not translate or equate to other degrees. NAME, PLACE AND COUNTRY ATTENDED FROM/TO DEGREES and ACADEMIC Mo./Year Mo./Year DISTINCTIONS OBTAINED MAIN COURSE OF STUDY B. SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION FROM AGE 14 (e.g. high school, technical school or apprenticeship) NAME, PLACE AND COUNTRY TYPE ATTENDED FROM/TO CERTIFICATES OR Mo./Year Mo./Year DIPLOMAS OBTAINED 21. LIST PROFESSIONAL SOCIETIES AND ACTIVITIES IN CIVIC, PUBLIC OR INTERNATIONAL AFFAIRS

20 22. LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN (Do not attach) 23. EMPLOYMENT RECORD: Starting with your present function, list in reverse order every employment you have had. Use a separate block for each FUNCTION. Include also service in the armed forces and note any period during which you were not gainfully employed. If you need more space, attach additional pages of the same size. Give both gross and net salaries per annum for your last and present FUNCTION. A. PRESENT FUNCTION (LAST FUNCTION, IF NOT PRESENTLY IN EMPLOYMENT) FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEA R MONTH/YEA R STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES SUPERVISED BY YOU: REASON LEAVING: FOR DESCRIPTION OF YOUR DUTIES

21 B. PREVIOUS FUNCTION (IN REVERSE ORDER) FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES SUPERVISED BY YOU: REASON LEAVING: FOR DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES REASON LEAVING: FOR SUPERVISED BY YOU:

22 DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES SUPERVISED BY YOU: REASON LEAVING: FOR DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR:

23 NO AND KIND OF EMPLOYEES REASON LEAVING: FOR SUPERVISED BY YOU: DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES REASON FOR LEAVING: SUPERVISED BY YOU: DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL

24 NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES REASON FOR LEAVING: SUPERVISED BY YOU: DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION: MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES REASON FOR LEAVING: SUPERVISED BY YOU: DESCRIPTION OF YOUR DUTIES FROM TO SALARY PER ANNUM EXACT TITLE OF YOUR FUNCTION:

25 MONTH/YEAR MONTH/YEAR STARTING FINAL NAME OF EMPLOYER: TYPE OF BUSINESS: ADDRESS OF EMPLOYER: NAME OF SUPERVISOR: NO AND KIND OF EMPLOYEES REASON FOR LEAVING: SUPERVISED BY YOU: DESCRIPTION OF YOUR DUTIES 24. DO YOU HAVE ANY OBJECTIONS TO OUR MAKING ENQUIRIES OF YOUR PRESENT EMPLOYER? YES NO 25. ARE YOU NOW, OR HAVE YOU EVER BEEN A PERMANENT CIVIL SERVANT IN YOUR GOVERNMENT S EMPLOY? YES NO If answer if "yes", WHEN? 26. REFERENCES: List three persons, not related to you, who are familiar with your character and qualifications. Do not repeat names of supervisors listed in item 24. FULL NAME FULL ADDRESS BUSINESS OR OCCUPATION

26 27. STATE ANY OTHER RELEVANT FACTS IN SUPPORT OF YOUR APPLICATION. INCLUDE INFORMATION REGARDING ANY RESIDENCE OUTSIDE THE COUNTRY OF YOUR NATIONALITY. 28. HAVE YOU 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 NO If "yes", give full particulars of each case in an attached statement. 29. 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 may result in the termination of the service contract or special services agreement without notice. DATE: SIGNATURE: NB. You will be requested to supply documentary evidence which support the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so and, in any event, do not submit the original texts of references or testimonials unless they have been obtained for the sole use of UNDP.

27 ANNEX 4