Personal History Form

This form allows you to apply or express interest for Field positions in the General Service and National Professional
categories, for Temporary Appointments in the Professional category, or for working under one of the affiliate schemes
(UNOPS, Individual consultant or contractor, deployee, secondee, etc.).

Please complete the form carefully, answering all mandatory sections fully and as completely as possible.

Your Personal History Form will be reviewed in the near future, and you will be contacted if you are short-listed for an
interview.
Note: Please do not contact UNHCR directly regarding the status of this application.

If you need assistance in completing this form, please contact UNHCR via the email address provided in the vacancy notice or
liaise with your nearest UNHCR Office.

1. GENERAL INFORMATION (Mandatory to complete)

Last Name Andi
Middle Name       Maiden Name      
First Name Hidayat
2. PERSONAL INFORMATION (Mandatory to complete)
Date of Birth (dd/mm/yyyy) 01/03/1995 Gender Male Female No Selection
Marital Status Married Single Divorced Common Law Registered Partnership
Separated Widowed
3. CONTACT INFORMATION (Mandatory to complete)
Current Address
Address Desa Blang Dalam Geunteng, Kecamatan Nisam, Aceh Utara.
City Aceh
Postal Code 24378 Country Indonesia

Permanent Address
Address Desa Blang Dalam Geunteng, Kecamatan Nisam, Aceh Utara.
City Aceh
Postal Code 24378 Country Indonesia

Preferred Contact Method Email Phone Post Mail

4. PHONE NUMBERS (Mandatory to complete)
Type Country Code Telephone # Ext. Indicate which is Preferred
Home               
Business               
Mobile 62 85294867077     
5. EMAIL ADDRESSES (Mandatory to complete)
Type Email Address Indicate which is Preferred
Home Hidayat403@gmail.com
Business nisamjayafarm@gmail.com
6. NATIONALITY INFORMATION (Mandatory to complete)
NATIONALITY INFORMATION Please list all COUNTRIES as applicable
Nationalities at Birth Indonesian
Current Nationalities Indonesian
Permanent Residency Indonesian

Print Date: 27 December 2020 Page 1 of 10

7. LETTER OF INTEREST (Mandatory to complete if applying for a specific vacancy announcement)
Please indicate the position you are applying for Protection Associate
Please answer the following questions.
1. How have your achievements and operational experience to date prepared you for this position?
Please refer to the job description and to the essential requirements therein. (1500 characters max)
I have been interested to work among people since I was at university, I had involved in a number of project among farmers
and fishermen where I had to stay or follow up the projects for months. One of the project I led even have been published and
presented at IOP Conference Series Earth and Environmental Science 2020. Starting from that, Even though I was working
part time as a staff of procurement and field supervisor at contractor and leveransir firm, I actively took part in some social
activities carried on through Student Executive Board of Syiah Kuala University. Following that, after finishing my study, I
started an agribussiness in a rural area of Aceh Utara where the rohingnya refugees landed. The agribusiness I established is
not only do the trading of agricultural product but also helping farmers through spesific financing models to connect financier
and farmers. In order to ensure the financier, i also regularly give training and taking close control at farmers activities.
Moreover, I also part of leading member in the farmer group of the region. Based of those experience, the knowledge of camp
location and set of skills I possesed, I consider that it would ease me or even be a benefit in the job as protection associate.

2. Please describe any skills and competencies you have, and which may be of particular relevance to this position.
(1500 characters max)
Being a protection associate requires the ability in stakeholder management, anlytical thinking, political awareness and a good
decision making. Those sort of competencies which I have developed during the project I got involve or been developing
through the footstep I have set when I run my agribusiness. I am also aware about the political condition in Lhokseumawe and
Aceh Utara Region, and quite a bit understand about the important of politics and the impact it can brings to social and
economic condition. For instance, I actively follow up the decision making and the decision being made in the council which I
would support or critisized depend on what it possibly cause to the specific group of people I oversee. I was born in Aceh Utara,
the location of refugees camp, I have involved and took care a number of project since 2015 there which allow me to learn a lot
about the location of this job, moreover, i also understand the culture, people perspective and speak the language of native
people around refugee camp which would help in decision making and negotiation.

3. How does this position align with your career aspirations? (1000 characters max)

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Despite my intention to develop the agribussines and empowering local farmers, I also widely concern about social and
humanity issues in Lhokseumawe and Aceh Utara region because in the future, I would like to be involved in more leadership
role, and possibly run for the election of District People's Representative Council. This job require a deep understanding not
only about social and economic condition, but also humanity and recent issues the government are dealing with. Related to
this, I have been dealing with economic and social issues in recent years, however, This protection associate job would allow
me to get involve with humanity aspect of this region. The rohingnya refugees are one of Aceh Utara's conscern due to its
location, and to me, engaging with such problem in professional approach would give me more knowledge and perspective
which would help me in term of making a proper decision in the future

8. WORK EXPERIENCE (Mandatory to complete, if any)

For all work experience, please complete as much information as possible.
Starting with your present position, list in REVERSE ORDER all employment you have had, using a separate block for each
work experience. Also include service in the armed forces. Note any period during which you were not gainfully employed.
Three blocks are provided; if you need more space, attach additional pages ensuring to give the same information requested
here.
Start Date 10/07/2020 End Date 10/07/2023 Full
(dd/mm/yyyy) (dd/mm/yyyy) Part-Time
Employer UD. Nisam Jaya Tani Check if ongoing
Job Title Owner
Supervisor Name -.
Employee Consultant Intern Self-employed
Type of Employment
UN Volunteer Volunteer Other
If ‘Other’ please explain      
Type of Workers Supervised Farm Workers # of Persons Supervised 8
Supervisor e-mail nisamjayafarm@gmail.com Supervisor Phone 6282294867077
Ending Pay Rate Amount 60000000 Currency IDR
(Annual Net)
Reason for Leaving -
Planning, finance, hiring, mentoring, and marketing.

Description of duties
(1200 characters max)

Employer Address line 1 Jl. Cot Mambong, Km 10. Desa Blang Dalam Geunteng
Address line 2 Kecamatan Nisam
Address line 3 Kabupaten Aceh Utara Postal Code 24378
City Aceh Country Indonesia
Governmental Organization International Organization
Type of Business
Non-Governmental Organization Private Sector Other
Is this UN Experience? Yes No Grade (if applicable)      
UN Index #      
Is this UNHCR experience? Yes No UNHCR MSRP ID      

Contract Type Fixed Term Indefinite Temporary Appointment Other Arrangement

If ‘Other Arrangement’ please indicate the Type of Arrangement
(e.g. UN Volunteer, UNOPS ICA, Individual Consultant, Intern, ICMC, Danish Refugee Council etc.)
     

Start Date 10/07/2018 End Date 10/07/2019 Full

(dd/mm/yyyy) (dd/mm/yyyy) Part-Time
Employer English Sutudio - Bedah IELTS Check if ongoing
Job Title Tutor
Supervisor Name Eddy Suaib

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 Employee Consultant Intern Self-employed
Type of Employment
UN Volunteer Volunteer Other
If ‘Other’ please explain      
Type of Workers Supervised       # of Persons Supervised     
Supervisor e-mail info@englishstudio.id Supervisor Phone 6281334439001
Ending Pay Rate Amount 30000000 Currency IDR
(Annual Net)
Reason for Leaving Establishing enterpreneurship
Teaching English for IELTS purpose.

Description of duties
(1200 characters max)

Employer Address line 1 Jl. Brawijaya No. 10, Pelem.

Address line 2 Kecamatan Pare
Address line 3 Kediri Postal Code 64212
City Jawa Timur Country Indonesia
Governmental Organization International Organization
Type of Business
Non-Governmental Organization Private Sector Other
Is this UN Experience? Yes No Grade (if applicable)      
UN Index #      
Is this UNHCR experience? Yes No UNHCR MSRP ID      

Contract Type Fixed Term Indefinite Temporary Appointment Other Arrangement

If ‘Other Arrangement’ please indicate the Type of Arrangement
(e.g. UN Volunteer, UNOPS ICA, Individual Consultant, Intern, ICMC, Danish Refugee Council etc.)
     

Start Date 28/07/2015 End Date 28/07/2017 Full

(dd/mm/yyyy) (dd/mm/yyyy) Part-Time
Employer C.V. Nisam Jaya Check if ongoing
Job Title Field Supervisor
Supervisor Name Huzaifah
Employee Consultant Intern Self-employed
Type of Employment
UN Volunteer Volunteer Other
If ‘Other’ please explain      
Type of Workers Supervised Construction # of Persons Supervised 20
Supervisor e-mail yusufhuzaifah136@gmail.com Supervisor Phone 6282272165378
Ending Pay Rate Amount 20000000 Currency IDR
(Annual Net)
Reason for Leaving Taking English Training
Supervising the workers on construction site, Checking materials deliverance, compiling
reports, dealing with or reporting problems on construction site to the supervisor.

Description of duties
(1200 characters max)

Employer Address line 1 Jalan Nisam No. 5, Sp IV, Krueng Geukueh

Address line 2 Kecamatan Dewantara
Address line 3 Kabupaten Aceh Utara Postal Code 24354
City Aceh Country Indonesia
Governmental Organization International Organization
Type of Business
Non-Governmental Organization Private Sector Other
Is this UN Experience? Yes No Grade (if applicable)      
UN Index #      

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 Is this UNHCR experience? Yes No UNHCR MSRP ID      

Contract Type Fixed Term Indefinite Temporary Appointment Other Arrangement

If ‘Other Arrangement’ please indicate the Type of Arrangement
(e.g. UN Volunteer, UNOPS ICA, Individual Consultant, Intern, ICMC, Danish Refugee Council etc.)
     

Print Date: 27 December 2020 Page 5 of 10

9. SPECIALIZED TRAINING (if any)
Course Title      
School Name      
Country      
Course Start Date       End Date      
(dd/mm/yyyy) (dd/mm/yyyy)
Topic area      
Training Methodology Assessment Blended Learning Programme Mobile Resource Material
Webinar Webinar for Blended Learning Workshop
Workshop for Blended Learning Training Video eLearning
Course Description      

Course Title      

School Name      
Country      
Course Start Date End Date      
     
(dd/mm/yyyy) (dd/mm/yyyy)
Topic area      
Training Methodology Assessment Blended Learning Programme Mobile Resource Material
Webinar Webinar for Blended Learning Workshop
Workshop for Blended Learning Training Video eLearning
Course Description      

10. EDUCATION (Mandatory to complete even if you have no formal education; if so, please indicate)
This space provides you with an opportunity to indicate that your academic credential or degree was obtained from an
educational institution that is recognised or sanctioned by a competent national authority, included in the IAU/UNESCO list.
When evaluating academic credentials of applicants, UNHCR is guided by the United Nations Educational, Scientific and
Cultural Organization's (UNESCO) listing (referred to as the "UNESCO list - World Guide to Higher Education (WHED)" ) of
higher education institutions recognized, and to determine the level of university degree conferred on candidates since the
level of degrees is not always consistent across countries.
Please CHECK THE SITE TO CONFIRM YOUR UNIVERSITY IS ACCREDITED. (website - www.whed.net)
Note: You must indicate the main language used for 75% or more of your studies, for each education item you list. 
Exact Title of S. TP (Bachelor of Agricultural Engineering)
Degree/Certificate
Begin Date (dd/mm/yyyy) 03/09/2013 End Date (dd/mm/yyyy) 02/05/2018
Main Major or Topic Agricultural Engineering
Other Majors/Topics of Water and Soil Engineering
Study
Elementary School Completed Some High School High School Graduate
Level Bachelor Masters Degree No Formal Education
Other (please specify in Comments)
Main language of your Indonesian
Education Completed? Yes No
studies
School Name Universitas Syiah Kuala
City Banda Aceh Country Indonesia
Comments      

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 Exact Title of      
Degree/Certificate
Begin Date (dd/mm/yyyy)       End Date (dd/mm/yyyy)      
Main Major or Topic      
Other Majors/Topics of      
Study
Elementary School Completed Some High School High School Graduate
Level Bachelor Masters Degree No Formal Education
Other (please specify in Comments)
Main language of your      
Education Completed? Yes No
studies
School Name      
City       Country      
Comments      

11. SKILLS (if any) List skills such as computer or technical programs, or other relevant functional ability.
Level # of Yrs Comments
(Low, Medium,
or High)
Skill MS Office High 15      
Skill Photography & Videography High 8      
Skill Data Management Medium 2      
Skill Graphic Design High 15      

12. LANGUAGES (Mandatory to complete)

Indicate your proficiency levels for each language, including for your A1 (beginner) A2 (basic)
Mother Tongue. B1 (pre-intermediate) B2 (intermediate)
Proficiency levels are listed from A1 to C2, and are based on the Common C1 (advanced) C2 (proficient)
European Framework of Reference for Languages; the website is below.
https://www.eui.eu/Documents/ServicesAdmin/LanguageCentre/CEF.pdf
Reading Speaking Writing Listening
Mother Tongue Language Indonesian C2 C2 C2 C2
2nd Language (if any) Acehnese C2 C2 C2 C2
(if applicable) Evaluation      
Date (dd/mm/yyyy)
3rd Language (if any) English C1 C1 C1 C1
(if applicable) Evaluation 09/02/2019
Date (dd/mm/yyyy)
th
4 Language (if any)                              
(if applicable) Evaluation      
Date (dd/mm/yyyy)

13. LICENSES AND CERTIFICATIONS (if any)

Issue Date (dd/mm/yyyy)       Expiration Date      
(dd/mm/yyyy)
Licence /Certification      
City       Country      
Is a renewal in progress? Yes No Licence /Certification      
Number
Issued By      

Issue Date (dd/mm/yyyy)       Expiration Date      

(dd/mm/yyyy)
Licence /Certification      
City       Country      

Print Date: 27 December 2020 Page 7 of 10

 Is a renewal in progress? Yes No Licence /Certification      
Number
Issued By      

14. THREE PROFESSIONAL REFERENCES (Mandatory to complete)

A Professional reference is a recommendation from a person who can vouch for your qualifications for a job.
This should not be the same person you listed as your supervisor for any of your work experiences.
Reference #1 - Name Khairuddin, S.T.
Title North Aceh District People's Representative Council     
Employer Member of District People's Representative Council
Phone Country Code Telephone # Ext.
62 85260080767     
Email Address khairuddinoppo813@gmail.com
Address line 1 Jl. Cot Mambong Desa Blang Dalam Geunteng
Address line 2 Kecamatan Nisam
Address line 3 Kabupaten Aceh Utara Postal Code 24387
City Aceh Country Indonesia

Reference #2 - Name Dr. Ichwana, S.T.,M.P.

Title Head of Agricultural EngineerinStudy Program
Employer Universitas Syiah Kuala
Phone Country Code Telephone # Ext.
62 81269000203     
Email Address Ichwana.ramli@unsyiah.ac.id
Address line 1 Jl. Tgk. Hasan Krueng Kalee No.3, Kopelma Darussalam
Address line 2 Kec. Syiah Kuala, Kota Banda Aceh
Address line 3 Kota Banda Aceh Postal Code 23111
City Aceh Country Indonesia

Reference #3 - Name Muliadi, S.T.

Title Director of C.V. Nisam Jaya - Contractor & Leveransir
Employer C.V. Nisam Jaya
Phone Country Code Telephone # Ext.
62 85260903434     
Email Address adymina@yahoo.co.id
Address line 1 Jl. Medan Banda Aceh, Desa Uteun Geulinggang
Address line 2 Kecamatan Dewantara
Address line 3 Kabupaten Aceh Utara Postal Code 24353
City Aceh Country Indonesia

15. QUESTIONNAIRE (Mandatory to complete)

1. Are you now, or have you ever been, a permanent civil servant in your government's employ? If the answer is yes,
please provide the dates below.
From Date       To Date      
Yes No
(dd/mm/yyyy) (dd/mm/yyyy)
2. Have you ever been arrested, indicted or summoned in court as a defendant in a criminal proceeding, or convicted,
fined or imprisoned for the violation of any law (excluding minor traffic violations)? If the answer is yes, please provide
details below.
Details      
Yes No
3. Have you ever been the subject of an investigation into allegations of misconduct?
Yes No
4. Have you ever been subject to disciplinary proceedings or measures?
Yes No
5. Would you accept employment for less than six months?
Yes No
6. Entry in United Nations service might require assignment to any area of the world in which United Nations might have
responsibilities. Are there any limitations on your ability to engage in your prospective field of work? If yes, please add
details below.

Print Date: 27 December 2020 Page 8 of 10

 Details      
Yes No
7. Entry in United Nations service might require assignment to any area of the world in which the United Nations might
have responsibilities. Are there any limitations on your engage in all travel? If yes, please add details below.
Details      
Yes No
8. Working with UNHCR requires field work in difficult, high-risk, and non-family locations. Do you commit to accepting a
deployment to such field operations?
Yes No
9. Do you have a spouse or any children? If yes, please provide below the names, dates of birth and the relationships.
Yes No
Name Birth Date (dd/mm/yyyy) Relationship
                 
                 
                 
                 
                 
                 
10. Have you taken up legal permanent residence status in any country other than that of your nationality?
If the answer is yes, please indicate the country.
Yes No Country      
11. State any other relevant facts. Include information regarding any residence outside the country of your nationality.
Details      
Yes No
12. Have you taken any legal steps towards changing your present nationality?
If the answer is yes, please add details below.
Details      
Yes No
13. Are any of your relatives, or is your spouse employed by a UN organization or Specialized Agency? If the answer is
yes, please indicate Name, Relationship, and Name of International Organization.
Yes No
Name Relationship Name of International Organization
                 
14. How did you hear about this vacancy?
UNHCR Career Website Campus Presentation by UNHCR Career Information Visit by UNHCR
Other UN Website Government Agency Social Media (LinkedIn, Twitter, etc.) Job Fair
Print Media Job Board (UNJobFinder, WhereWomenWork, ReliefWeb, Devex, Monster, etc.)
Professional Association Referral by a friend Other

CONFIRMATION AND CONSENT (Mandatory to complete)

Print Date: 27 December 2020 Page 9 of 10

To complete your application you are required to confirm the following:
ACCURACY OF CONTENT: The content of this application is accurate and contains no false information;
EDUCATION INFORMATION - You give your full consent and authorize the Office of the United Nations High Commissioner
for Refugees (UNHCR) to contact each of your educational institutions listed in this application for the purpose of conducting
required reference checks with regard to your educational background, and to confirm the diploma or degrees you have
received at each educational institution.
You also authorize the mentioned educational institutions to provide requested information directly to UNHCR. Any information
received from your educational institutions will be treated with due regard to all confidentiality requirements; and,
WORK EXPERIENCE - You are aware UNHCR will contact former and current employers, if applicable, regarding Work
Experience, as well as check your three Professional References.
Finally, you understand that submission of false information or misrepresentation and/or submission of falsified
documentation constitutes serious misconduct for which severe disciplinary sanctions can be imposed.

I consent to all of the foregoing as part of the process of evaluation of my application.

DATE : _______________________ SIGNATURE: _____________________________

Print Date: 27 December 2020 Page 10 of 10