Applicant Bio-Data Sheet

Date:

1. Name:

2. Permanent mailing address:

3. Temporary mailing address (please include the dates for which this address is valid):

4. Telephone Number
a. Home:
b. Work:
c. Fax:
d. Other (specify cell, pager, friend, etc.):

5. E-mail:

6. Alternate e-mail:

7. Dates available (please list dates when you ARE and ARE NOT available):

8. Salary history (please include dates and salary of three most recent/relevant
positions):

Emergency Contact Information

9. Name and relationship:

10. Telephone Number:

Home:
Work:
Other (Specify person and relationship if different from above, cell, pager, etc.):

12. E-mail:

13. Alternate e-mail:

14. Language proficiency (please list any languages in which you are proficient). Also
indicate your level of proficiency for each language using the following scale:

• Elementary proficiency (S-1)

• Limited working proficiency (S-2)
• Professional working proficiency (S-3)
• Full professional proficiency (S-4)

PC-OACM-735 (08/2005)
 • Native or bilingual proficiency (S-5)

Training Experience

Please note that this information MUST be in your résumé as well. This
Bio-Data form does not replace the information that is in your résumé.

Please use the following formats for listing each

Peace Corps or non-Peace Corps training experience:

Peace Corps Training Experience

Country:
Official Title of Position: (e.g., Health Technical Trainer for Pre-Service Training, PCV)
Compensation: (daily rate, Volunteer stipend, salary, etc.)
Start Date: End Date:
Contract Number: (located on top of first page of contract)
Hired Through: (Peace Corps HQ, Peace Corps post, other)

Brief Description of Work:

Non-Peace Corps Training Experience

NOTE: Please highlight your experiences educating adults in non-classroom setting with
hands-on/experiential-based sessions.

Country:
Organization: (e.g.,World Bank, Chemonics, etc.)
Official Title of Position: (e.g.,Health Technical Trainer, Small Business Consultant, etc.)
Compensation: (daily rate, salary, etc.)
Start Date: End Date:

Brief Description of Work: (# of days, # of people, topic, etc.)

PC-OACM-735 (08/2005)
Please list all Peace Corps and non-Peace Corps training experience in this format and return, as
an e-mail attachment only, to the Short-Term Assistance Unit at
stau@peacecorps.gov.

PC-OACM-735 (08/2005)