INTERNATIONAL ORGANIZATION FOR MIGRATION

768/12 Thirbam Sadak

Baluwatar-5, Kathmandu
If you are applying for a specific P.O. Box: 25503
Vacancy Notice, please quote NEPAL
relevant position title and vacancy
number:

Applications must be filed in one

of IOM's official languages
PERSONAL ATTACH
PHOTOGRAPH
(English, French or Spanish).
Applications in other languages HISTORY HERE
may be rejected. Make sure you
complete all four pages of the
personal history form.

1. A) Surname First Name Middle Name Maiden Name, if any

Shah Ashish
B) List any other names used
2. A) Permanent Address B) Telephone No.
Dhangadhi-07,Kailali,State-7, Nepal
9848421785, 091523544
3. A) Present Residence (Specify City, Province or State, Country) B) Since (date) Until (anticipated date) C) Telephone No.
9848421785,
Dhangadhi-07,Kailali,State-7, Nepal
091523544
D) E-mail address (1) E) E-mail address (2), if applicable
Blinkasish@gmail.com
4. A) Place of Birth B) Date of Birth C) Citizenship at Birth D) Present Citizenship
(If Swiss, canton and origin)
14-Sep-91 Nepali Nepali
Dhangadhi-07,Kailali,State-7, Nepal
E) Passport or Identity Card No. Date of Issue/Date of Expiry Place of Issue (in full)

5. Sex (Check) 6. Marital Status (Check)

Fem Sing Marri Wido Divor Separat
✘ Male ✘
ale le ed w(er) ced ed
Ye
7. Have you any depedents? ✘ No If answer is "Yes" give following information:
s
Name Age Relationship Name Age Relationship

8. LANGUAGES
(List mother tongue first)
READ WRITE SPEAK
Language
Excellent Good Poor Excellent Good Poor Excellent Good Poor
Nepali Yes Yes Yes

English Yes Yes Yes

Hindi Yes Yes Yes

Tharu Yes Yes Yes

Local Languages of State 7 Yes Yes Yes

Page 1 of 4
9. EDUCATION: Give full details, using the following space in so far as it is appropriate of schools or other formal training or education from age
high school, technical school, apprenticeship, university or its equivalent):
Years attended Certificates, diplomas, de
Name and Place Type
From To academic distinctions ob
Nobel College,Pokhara University, Kathmandu
University 2009 2014 Public Health, 2.65 C
Nepal
HSEB,Aishwarya Vidhya Niketan, Dhangadhi
High School 2006 2008 Intermediate in Science,
Nepal
SLC,Aishwarya Vidhya Niketan, Dhangadhi Nepal SLC Board 1994 2005 SLC Certificare, 67.5

B) List any special skills you possess and machines

10. A) Indicate speed in words per minute (if applicable) equipment you can use
Other Languages Experience of using all electrical devices used at
English French Spanish Learning by experiment and smart technologies
Shorthand Youtube and search engines.
Typing
11. List all organizations with which you are or have been affiliated. This list is to include all affiliations, whether social, professional, fraternal, et
Nepal Red Cross Society, Dhangadhi Jaycees-Sport Coordinator, Amnesty International- Individual Member, Chairman of Flatland Re
Hub, Managing Director of Flatland Futsal

12. List activities in civic, public or international affairs and name any significant publications you have written.
Volunteer in Different Social Programs

13. For what kind of work do you wish to be considered?

Unbiased work for Humanitarion support which are proposed by Project.

14. A) Are you willing to accept a post requiring travel? Yes

B) Would you accept short term employment? Yes

C) Would you accept an emergency field assignment at short notice? Yes

15. In the event of your being selected, how much notice would you need before appointment?
2 Days

16. Have you any objections to our making inquiries of your present employer? Yes ✘ No
is appropriate of schools or other formal training or education from age 14 (e.g.

Certificates, diplomas, degrees or

academic distinctions obtained
Public Health, 2.65 CGPA
Intermediate in Science, 50.40%
SLC Certificare, 67.50%

B) List any special skills you possess and machines and

equipment you can use
Experience of using all electrical devices used at ofiices.
Learning by experiment and smart technologies in
Youtube and search engines.

st is to include all affiliations, whether social, professional, fraternal, etc.

nesty International- Individual Member, Chairman of Flatland Recreation

ficant publications you have written.

roject.

Yes

Page 2 of 4
17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged,
accounting fully for your time. List military service and any period of unemployment of more than six months' duration. Use a separate block
for each period and additional sheets if necessary.
Present or most recent occupation
Dates Annual emoluments:

From To Salary 660,000.00

(month/year) (month/year)
Allowances 55,000.00
Oct-17 Feb-19
Total 715,000.00
Business or organization (name and address, including city)
Nepal Red Cross Society, Dhangadhi, Kailali
Title of your post or Name of Supervisor
occupation
Disrtict Program Officer Sabin Adhikari
Number and kind of employees supervised by you
One Accountant
Personal address during this period
Dhangadhi Kailali
Reason for leaving
Project Phase Out
Dates Total annual emoluments:
520000
From To
(month/year) (month/year)

Nov-16 Oct-17

Business or organization (name and address, including city)

FAYA Nepal( Forum for Awarness and Youth Activity) Dhangadhi, Kailali
Title of your post or Name of Supervisor
occupation
Field Coordinator Dharma Raj Pathak
Number and kind of employees supervised by you
31 ( Accountant,DMO,DEP,Field Supervisor and CNF)
Personal address during this period
Dhangadhi, Kailali
Reason for leaving
Got better oppournity during renewal period
Dates Total annual emoluments:
520000
From To
(month/year) (month/year)

May-15 Apr-16

Business or organization (name and address, including city)

FAYA Nepal( Forum for Awarness and Youth Activity) Dhading
Title of your post or Name of Supervisor
occupation
Hygiene Expert Sacchidananda Joshi
Number and kind of employees supervised by you
18( Hygiene Promoter and Social Mobilizer)
Personal address during this period
Dhadingbesi, Dhading
Reason for leaving
Project Phase out
e order each activity in which you have been engaged,
ment of more than six months' duration. Use a separate block

Description of duties and responsibilities

District based focal point for the overall coordination and
management of the program. Coordinate and maintain
working relationship with DPHO, Hub and satellite
hospitals, Ambulance committees and other local
government institutions. Help facilitate proper coordination
within program districts, other NRCS activities and EU
partners. Ensure implementation of the program in line with
the program document, DG ECHO guidelines and NRCS
policies and guidelines. Implementation of the Program
activities as per POA in district. Engage and maintain
relationship with WHO Consortium partners, DPHOs, Hub
hospitals, Ambulance committees, health posts, PHCC other
health institutions and local government. Ensure capacity
building and dissemination on emergency referral protocol
at local level. Build capacity of Ambulance service providers,
FCHVs, PHCC, Health post and local DM Committees and
government on pre hospital safety. Ensure development of
district specific emergency health volunteer’s deployment
and coordination mechanism. Develop monthly reports and
share it with Field Hub Office for compilation. Collaborate
with ENCOE, DP DRR Program to ensure integrated
Description of duties and responsibilities
Support to district Coordinate for conducting district
orientation and develop Detailed Implementation Planning
(DIP) with District Health offices, DCC, and NGO and other
stakeholders. Coordinate to conduct district level
stakeholder planning, meeting, orientation, training and
other relevant activities of Suaahara. Plan and implement
project activities in the working district. Coordinate with
Suaahara II District Office to implement program effectively
and smoothly. Coordinate and liaison with DDC /VDCs to
allocate fund for the Suaahara activities in the district.
Coordinate Suaahara II district team, district line agencies,
related offices and networks for planning and implementing
Suaahara II program activities. Supervise and monitor the
field program and provide constructive feedbacks to filed
team. Ensure close monitoring of activities and performing
field visits in order to assess the implementation of Suaahara
activities. Provide support and program input to field
supervisors and where need to Female Community Health
Volunteer (FCHVs)/ Village Model Farm (VMF), Outreach
Clinics, Ward Citizen Forums, Citizen Awareness Centers
Description of duties and responsibilities
(CAC) Support /Conduct/ organizes various district and
Support
communityTeam
to Leader fortrainings,
level activities, conducting district orientation
workshops and other
and develop Detailed Implementation
required activities. Monitor, mentor and supervise to field
Planning(DIP).Coordinate
supervisors. Prepare monthly/ to conduct meeting, orientation,
quarterly/semiannual/annual
training and other
plan.Produce relevant
& submit activities.
quarterly/ Coordinate
semiannual and liaison
/ annual
with DCC/VDCs. Planning and monitoring of
reports of the programs on time. Collect and document WASH related
activities. Provide technical support to community
important case studies/stories. Provide support to the mobilize
and Hygiene
evaluation andpromoters.
monitoring Supervise and monitor
team (baseline, midtermthe field
and
program and provide
final) .Attend constructive
and share feedbacks
program progress andtochallenges
team. in
Ensure
district close monitoring ofreview
level stakeholders' activities and performing
meeting field
in coordination
visits in ordercoordinator
with district to assess the implementation of Earthquake
response activities. Provide support and program input to
Hygiene promoters and where need to Female Community
Health Volunteer (FCHVs), Ward Citizen Forums.
Support /Conduct/ organizes various district and community
level activities, trainings, workshops and other required
activities. Monitor, mentor and supervise to field Staffs’
Prepare monthly/quarterly/semiannual/annuals plans
related to Hygiene. Collect and document important case
studies/stories.
Page 3(a) of 4
17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged,
accounting fully for your time. List military service and any period of unemployment of more than six months' duration. Use

Present or most recent occupation

Dates Annual emoluments:
From
(month/year) To Salary
300,000.00
(month/year)
Allowances
25,000.00
Oct-13 Sep-14
Total
325,000.00
Business or organization (name and address, including city)
FAYA Nepal( Forum for Awarness and Youth Activity) Dhangadhi, Kailali
Title of your post or Name of Supervisor
occupation
Program Officer Dharma Raj Pathak
Number and kind of employees supervised by you
4 (Field Supervisor)
Personal address during this period
Dhangadhi Kailali
Reason for leaving
Transferred to Dhading after Earthquake as Rapid response team.
Dates Total annual emoluments:

From To
(month/year) (month/year)

Business or organization (name and address, including city)

Title of your post or Name of Supervisor

occupation

Number and kind of employees supervised by you

Personal address during this period

Reason for leaving

Dates Total annual emoluments:

From To
(month/year) (month/year)

Business or organization (name and address, including city)

Title of your post or Name of Supervisor

occupation

Number and kind of employees supervised by you

Personal address during this period

Reason for leaving

e order each activity in which you have been engaged,
ment of more than six months' duration. Use

Description of duties and responsibilities

Follow guideline, curriculums and Maternal and Neonatal
Health (MNH) packages and plan; ensure quality
implementation of training programs (SBA, Implant Insertion
and Removal, IUCD) at district to community level. Develop
and apply Behavior Change Communication (BCC) activities to
promote and adopt healthy behaviors related to Reproductive
Health (RH)/Safe motherhood and Family Planning.
Prepare yearly and periodic implementation plan. Plan,
implement and ensure active participation of women in meeting
and community level campaigns. Facilitate, ensure good
monitoring mechanism and make regular joint field visit with D
(P) HO staff focusing on excluded group and needy areas for
quality/sustainable output of the project activities.
Updates the project-monitoring database in disaggregate form
based on Project Information Management System.Support to
conduct midterm and final evaluation of the project activities
and other small-scale studies. Document and encourage staff to
conduct activities for project implementation process, successes,
failures and lesson learned and good practices for wider
dissemination. Ensure issues of PVSE groups in planning,
implementation, monitoring and evaluation of the activities.
Description of duties and responsibilities

Description of duties and responsibilities

Page 3(b) of 4
17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged,
accounting fully for your time. List military service and any period of unemployment of more than six months' duration. Use

Present or most recent occupation

Dates Annual emoluments:

From To Salary
(month/year) (month/year)
Allowances

Total -
Business or organization (name and address, including city)

Title of your post or Name of Supervisor

occupation

Number and kind of employees supervised by you

Personal address during this period

Reason for leaving

Dates Total annual emoluments:

From To
(month/year) (month/year)

Business or organization (name and address, including city)

Title of your post or Name of Supervisor

occupation

Number and kind of employees supervised by you

Personal address during this period

Reason for leaving

Dates Total annual emoluments:

From To
(month/year) (month/year)

Business or organization (name and address, including city)

Title of your post or Name of Supervisor

occupation

Number and kind of employees supervised by you

Personal address during this period

Reason for leaving

e order each activity in which you have been engaged,
ment of more than six months' duration. Use

Description of duties and responsibilities

Description of duties and responsibilities

Description of duties and responsibilities

Page 3(c) of 4
18. References: List three persons not related to you who are familiar with your character and qualifications. Do not repeat names of supervisors listed
under Item 17.
Name in full Complete Address (Telephone No. if known) Business or Occupation
Uttam Joshi Dhangadhi, Contact No. 9858421333 President Nepal Red Cross Society, Kailali
Sher Bahadur Basnet Dhangadhi, Contact No. 9858420854 Chairman, FAYA Nepal
Prakash Bist Dhangadhi, Contact No. 9848422544 Chairman, CCS Nepal

19. (a) Have you ever been arrested, indicted or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned or placed
on probation in connection with such a proceeding, or have you ever been arrested or required to deposit bail or collateral for the violation of any law or
regulation, civil or military (excluding traffic violations)?

Answer Yes ✘ No

(b) If your answer is ''Yes'' under item 19 (a) above, attach separate sheet giving details of all arrests and fines other than minor traffic violations.
Specify charge, date, place where arrested, and disposition.

20. State any other relevant facts. Include information regarding any residence or prolonged travel abroad, give dates, areas, purpose, etc. State any
significant experience not included in Section 17 which you believe will serve in the evaluation of your record.

Emgage as a Rapid Response team from FAYA Nepal after earthquake in Dhading District. Accept all the challenges in the five VDCs of Dhading
District. Training facilitation on WASH,DDRT Health,Mobile software for data collection and so on.

21. State any disabilities which might limit the performance of your work.
(Appointment is subject to compliance with medical requirements.)

Having answered every question above, I, the undersigned, declare that the information contained in this form is, to the best of my knowledge, true,
complete and accurate, knowing that, if employed, any false declaration or concealment of material facts may result in disciplinary action including
dismissal.

Place and Date Signature

PLEASE NOTE

Applications will not, as a general rule, be valid or retained by the Organization for more than one year from date of receipt. While you may rest assured
that your candidature will be carefully examined, receipt of this form will not be acknowledged, and any further correspondence will be initiated by the
Organization.

Page 4 of 4