PRE-EMPLOYMENT SCREENING FORM

Introduction:
Free Press Unlimited works to ensure that reliable news and information are and remain available
to people across the globe. Particularly people in countries where there is little to no press
freedom. At the same time, it is very important to understand that working for Free Press Unlimited
comes with certain risks towards staff and programmes. Accepting a position at Free Press
Unlimited means also being aware of the risks we run as an organisation and to understand the
importance of the protection of all sensitive and/or confidential information. You must understand
that security at Free Press Unlimited comes with great responsibilities for yourself, your colleagues
and in particular our local partners abroad!

Therefore safety and security is of the highest priority for FPU and an integral part of the
organisation’s duty of care to its staff. This includes the protection of our local partners and projects
abroad. Free Press Unlimited sees qualified and reliable staff as absolute condition to achieve it's
goals. The pre-employment screening is part of that process.

Because you qualify for a position at Free Press Unlimited you will be asked to fill out this form.
You MUST fill out this form completely and truthfully. All information provided will be treated
confidentially according the EU General Data Protection Regulation (GDPR). For more detailed
information see our privacy statement on the Free Press Unlimited website.

Free Press Unlimited will not retain this form any longer than is necessary. This form will be kept
securely and in confidence. Access to this information will be restricted to designated persons,
within the organisation who are authorized to view it as a necessary part of their work.
By signing this form you consent to the conduct of this security check. Free Press Unlimited will
only use the information gathered for pre-employment screening purposes and will delete all
information after your employment with Free Press Unlimited is ended.

Personal details:
Surname
Given names
Date of birth
Social security number
Place and country of birth
Citizenship (note if dual)
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Languages spoken

Identification document(s):
First passport:
- passport number
- place of issue
- date of issue
- date of expiry
Second passport: (if any)
- passport number
- place of issue
- date of issue
- date of expiry

Contact details:
Address

Postal code
City
Country
Phone number – home
Phone number – work
Phone number – cell
Email address – work
Email address – personal
Others

Marital status:
Married: Date:
Committed relationship: Date:
Divorced: Date:
Single: Date:
Other: Date:
Children: Age:

Previous addresses where you have been living for the past 6 years:
Address

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Postal code
City
Country
Period
Address
Postal code
City
Country
period
Address
Postal code
City
Country
Period
Address
Postal code
City
Country
Period

Education:
Institute (Name and place)
Study
Certificate
Period
Institute (Name and place)
Study
Certificate
Period
Institute (Name and place)
Study
Certificate
Period
Institute (Name and place)
Study
Certificate
Period

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Employers for the last 6 years:
Employer (Name)
Address
Postal code
City
Country
Position
Employer (Name)
Address
Postal code
City
Country
Position
Employer (Name)
Address
Postal code
City
Country
Position
Employer (Name)
Address
Postal code
City
Country
Position

Other associations, organizations, groups that you belong to or have been a member for
the last 6 years:
Name
Address
Postal code
City
Country
Period
Position
Name
Address
Postal code
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City
Country
Period
Position
Name
Address
Postal code
City
Country
Period
Position
Name
Address
Postal code
City
Country
Period
Position

Integrity and conduct

In Free Press Unlimited we will not tolerate any form of misconduct, including sexual harassment,
exploitation and abuse. We have a code of conduct in place, and are committed to creating a
culture of integrity in the organization where misconduct is not tolerated, situations of abuse are
quickly investigated and perpetrators are dealt with effectively.
Have you ever had any formal disciplinary sanction regarding your YES / NO
conduct in any former employment or voluntary service?
If yes, please give details:

Please note that a prior sanction may not be a bar to employment with Free Press Unlimited, you
will be given an opportunity to explain the circumstances surrounding the sanction if you are
invited to interview.

The undersigned hereby certifies that he/she never have been in contact with the police or
prosecutor of an offense concerning theft, vandalism, assault, harassment and other crimes. If
necessary, a certificate of good conduct to Free Press Unlimited will discuss if requested by Free
Press Unlimited.

Has no objection to gathering information by Free Press Unlimited on previous education and
employment. Having taken note of the Free Press Unlimited Code of Conduct and Legal
Regulations in respect of criminal activity and never been fired before in connection with acts of
criminal activity or illegal behavior.
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Understands the importance of security within the organisation and the responsibility towards our
local partners abroad

The information given on this form is true and complete to the best of knowledge and belief. In
addition, understanding that any false information or deliberate omission in the information has
given on this form may disqualify for employment.

Date: __________________________

Place: __________________________

Name: ______________________________ Signature: __________________________

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Pre-employment screening – Free Press Unlimited – ISL 4 Confidential Version V4-08/2019