Affix

JOB APPLICATION FORM

‫فورمه درخواستی برای کا ر‬
Afghanistan
1. Name as in National ID MirAfghan 2. Father Salman Ali 3. Sex Male
Card ‫میرافغان‬ Name ‫نام پدر‬ ‫سلمانعلی‬ ‫جنس‬ ‫مرد‬
‫نام طوریکه در تذکره تابعیت است‬
4. Date and Place of Birth Date: (10 / 08 / 1368) ‫ تاريخ‬Province :) Ghazni ) ‫واليت‬District: Malistan
‫محل تولد تاریخ و‬ ‫) ) ولسوالی‬ ‫مالستان‬:

Village:) Wardah Maknak ) ‫قریه‬: National ID Card #: ( 773754 )‫نمبر تذکره تابعیت‬

5. Present Address Province :) Ghazni) ‫والیت‬: District:( Malistan (‫ولسوالی‬: Village: Wardah Maknak) ) ‫قریه‬:
‫فعلى سكونت‬
Contact #: ( 0791903868 - 0779980766 ) ‫شماره های تماس‬: , E-mail (
mir.ghulamipoor1400@Gmail.com ) ‫ایمیل‬

6. Permanent Address: Province: Ghazni) ‫والیت‬: District: ) Malistan )‫ولسوالی‬:

‫اصلى سكونت‬ Village:) Wardah Maknak) ‫قریه‬: Contact # (0779980766-0791903868) ‫شماره تماس‬:

7. Job applied for: ( CHS )‫ وظيفه ايکه برايش درخواستی ميدهيد‬, Vacancy # (CARE-AF—0553 Paktika ) ‫شماره پست‬:

8. Have you previously submitted application to any of CARE vacant position?

‫آیا درگذشته به کدام پست در کی یر درخواست نموده اید؟‬
Yes ( ) ‫بلی‬ No ( NO ) ‫نخیر‬
If yes, When? ‫اگربلی چه وقت‬ Date ( ) ‫ تاریخ‬Position: ( ) ‫پست‬
9. List all languages you know. Begin with your mother tongue first:
‫تمام لسانهای را که میدانید لست نمایید ازلسان مادری تان شروع نموده‬
Languages Read ‫خواندن‬ Write ‫نوشتن‬ Speak ‫صحبت نمودن‬ Understand ‫درک نمودن‬
Easily Not Easily Easily Not Easily Easily Not Easily Easily Not Easily
‫به آسانی‬ ‫به مشکل‬ ‫به آسانی‬ ‫به مشکل‬ ‫به آسانی‬ ‫به مشکل‬ ‫به آسانی‬ ‫به مشکل‬
DARI Easily Easily Easily Easily

Pashto Easily Easily Easily Easily

English Easily Easily Easily Easily

10. As per the Country Office Nepotism policy and in order to promote diversity, CARE does not encourage the
employment of close relatives of existing staff. Close relatives here is defined as relationships established by blood,
marriage or legal action ( husband, wife, mother, father, son, daughter, sister, brother, aunt, uncle, niece, nephew,
cousins, step and/or half siblings related by marriage of either one or both parents and
mother/father/brother/sister/son/daughter (in-law) grandfather, grandmother, grandson). Any other forms of existing
relationship not listed above needs to be declared.

Do you have any form of relationship, not described above, with any of the current staff working with CARE
Afghanistan? Yes (    ) No (   ).  If yes please provide the following details:  
‫ دفتر کی یر استخدام اقارب نزدیک کارمندان خود را تشویق نمیکند تعریف اقارب نزدیک چنین استء‬،‫ اقربا پروری و به منظور ترویج تنوع‬d‫بر اساس پالسی‬
،‫ پسر و دختر ماما‬،‫ خواهرزاده‬،‫ کاکا‬،‫ ماما‬،‫ عمه‬،‫ خاله‬،‫ برادر‬،‫ خواهر‬،‫ دختر‬،‫ پسر‬،‫ پدر‬،‫ مادر‬،‫ خانم‬،‫ شوهر‬:‫ازدواجی یا به وسیله حکم قانونی)چون‬،‫(قرابت نسبی‬
‫ مادر کالن و نواسه به میان می آید‬،‫ پدر کالن‬،‫ دختران و پسران آنها‬،‫ خیاشنه‬،‫ خسربره‬،‫ خشو‬،‫ قرابتی که از اثر ازدواج خسر‬/‫ عمه و خاله اقارب ناسکه‬،‫کاکا‬.
‫هر نوع قرابتی موجوده دیگری که در باال ذکر نشده باشد باید اظهار شود‬
            :‫ ) اگر بلی لطفا شرح آنرا در جدول ذیل بنویسید‬NO ( ‫آیا شما با کارمندان بر حال پاملرنه کدام نوع قرابتی که در باال ذکر نشده دارید؟ بلی( ) نه‬

S/N Name ‫اسم‬: Position in CARE Duty Station Relationship ‫رشته‬:

‫وظیفه درپا ملرنه‬ ‫محل وظیفه‬
11. Education: ‫تحصيالت‬
Give full details in chronological order starting with the most recent.
‫تحصیالت تانرا ازدوره عالی اغاز نموده بطورمفصل معلومات ارايه بداريد‬.
Institute ‫انستيتيوت‬ Years Attended Degree or qualification obtained Main course of
‫سالهای شمول‬ ‫شهادت نامه‬ study or
From ‫از‬ To‫الی‬ specialization
DD/MM/YY DD/MM/YY ‫رشته اختصاصی‬
Economy’s 2019 2022 NO BBA
Nursing 2014 2016 Yes Nurse

12. List the computer programs you know: ‫پروگرامهای کمپیوتر که میدانید لست نمائید‬.
MS: Word, Excel, PowerPoint, Outlook , KOBO Data Collection software
13. Relevant Training, Courses or Workshops Obtained in chronological order starting with the most recent:
. ‫ اخير آغاز نموده به عقب برويد‬/‫ از فعلی‬.‫ تریننگها و ورکشاپها را بنوسید‬,‫کورس های آموزشی‬
Institute ‫انستيتيوت‬ Subject ‫موضوع‬ Period Attended
‫مدت شموليت‬ Location‫موقعيت‬
From ‫از‬ To‫الی‬
DD/MM/YY DD/MM/YY

14. Employment/Working record‫ تجربه کاری‬:

List in chronological order your employments. Start with the most recent and for each job use a separate section includes
five recent jobs.
‫ اخير آغ از نموده به عقب رفته پنح وظیفه تانرا که انجام داده اید بصورت‬/‫ از وظيفه فعلی‬.‫جداگانه لست نما ئید‬
Organization Position Held Period ‫مدت‬ Duty Location Reason for Leaving
From ‫از‬ To‫الی‬
‫اداره‬ ‫وظیفه‬ DD/MM/YY DD/MM/YY ‫محل وظیفه‬ ‫دلیل ترک کردن‬
BRAC- Health Educator 26/09/2022 31/03/2023 Shebar End of Project , Nor
AFGHANISTAN District, Extend
Bamyan
Province
Major Responsibilities/duties of the position: ‫مسولیتها ی عمده وظیفه‬
Main duties Performed.
Assessing the needs of people and communities for health education.
Educating people about the importance and package of health care services through MHT.
Educating people about health and nutrition issues and good diet performance.
Collecting data and preparing weekly and monthly report to the supervisor
Providing Trainings all related health, nutrition.
Coordinating with society and raising health and hygiene capacities through health education
Close collaboration with all MHT Members.
Provide Treatment for SAM and MAM under 5 children
Health care nursing and support MHNTs
Support medical doctors of the Mobile Health and Nutrition team in managing prescriptions and distribution
of medicines.
Routine nursing activity such as IV fluid, injection, dressing, and taking care of wounds including burn
cases
Health and hygiene(WASH) Education for MHNT beneficiaries

Support Nutrition counselors

Organization Position Held Period ‫مدت‬ Duty Location Reason for Leaving
From ‫از‬ To‫الی‬
‫اداره‬ ‫وظیفه‬ DD/MM/YY DD/MM/YY ‫محل وظیفه‬ ‫دلیل ترک کردن‬
AKF-A CHPA 01/01/2017 30/12/2018 Bamyan End of
Contract ,Refer to
other Position
Major Responsibilities/duties of the position: ‫مسولیتها ی عمده وظیفه‬
Main Duties Performed
 Regular visits to communities and support for community-based health promotion volunteers
 Recruitment and training of community-based health volunteers with the support of religious
leaders and elders
 Coordination of activities on various health issues in support of medical activities, including the
promotion of health knowledge, promotion of health and medical services in relation to
malnutrition of pregnant and lactating mothers, monitoring of death and death
 Regular support for CHVs volunteers throughout the covered area
 Planning for regular visits to communities and monitoring to ensure the quality of services and
collect accurate data on the health activities of the community
 Weekly update report for community health officer on the progress of CBHVs
 Monitoring the information collected and analyzing the CHVs report on community activities
Organization Position Held Period ‫مدت‬ Duty Location Reason for Leaving
From ‫از‬ To‫الی‬
‫اداره‬ ‫وظیفه‬ DD/MM/YY DD/MM/YY ‫محل وظیفه‬ ‫دلیل ترک کردن‬
AKF-A WASH Assistant 02/02/2018 31/02/2018 Bamyan With End of Project and
Travel To Nor Extends
District
Major Responsibilities/duties of the position: ‫مسولیتها ی عمده وظیفه‬
Main duties Performed
 Responsible for conducting WASH assessments at the community and school level. Preparation of health
education materials and preparation of methods and agendas for the implementation of health awareness
meetings, holding health meetings and exercises at the school and community level.
 Prepare/participate in technical assessments related to WASH (servicing, boreholes, hand washing facilities,
etc.).
 Assisting in technical guidance and ensuring the high technical quality of projects. Monitor WASH activities
regularly and within the agreed time period. Distribution of sanitary materials under the direct supervision of
the WASH officer/coordinator to implement health promotion training, awareness sessions and community
mobilization.
 Monitoring WASH activities and the impact of sensitization sessions and organizing and providing health
promotion sessions for target populations (community and school).
Participation in the implementation of clean-up campaigns (including community mobilization, community
meetings, door-to-door visits,) from planning to implementation and monitoring of proper sanitation practices
among stakeholders and their motivation.
 Distributing health packages to the target beneficiaries and maintaining distribution documents, carrying out
children's health promotion activities in schools.
 Assist the WASH Coordinator in monitoring water and sewage and other construction activities.
 Preparation of reports based on the needs of the project on a regular basis. Participation in the implementation
of other health promotion activities and other tasks assigned by the supervisor .
Organization Position Held Period ‫مدت‬ Duty Location Reason for Leaving
 From ‫از‬ To‫الی‬
‫اداره‬ ‫وظیفه‬ DD/MM/YY DD/MM/YY ‫محل وظیفه‬ ‫دلیل ترک کردن‬
‫شفاخانه بیست بستر عارف‬ ‫ نرس‬ER Nurse 01/01/94 29/12/1394 Ghazni Fined Other Job
‫ندا‬
Major Responsibilities/duties of the position: ‫مسولیتها ی عمده وظیفه‬

Main Duties Performed

 Delivery of the patient from a triage nurse or a CPR nurse.
 Establish a proper and effective communication with the patient and his companions
 Controlling the patient's breathing, cardiovascular condition and alertness, etc.
 Recording unusual cases such as blindness or low vision of one eye or both eyes, deafness, moral
disorder, etc. in the patient's file.
 Controlling cases of drug allergies or taking certain medications and registering in the file
 Control and registration of past illness
 Control and registration of causes related to the harassment and harassment of children, women, the elderly
and the mentally handicapped, and report to the official in charge of the hospital.

Organization Position Held Period ‫مدت‬ Duty Location Reason for Leaving
From ‫از‬ To‫الی‬
‫اداره‬ ‫وظیفه‬ DD/MM/YY DD/MM/YY ‫محل وظیفه‬ ‫دلیل ترک کردن‬

Major Responsibilities/duties of the position: ‫مسولیتها ی عمده وظیفه‬

15. Any other information considered relevant for the position:‫هر گونه معلومات دیگرکه مناسب بودن کاندید را به پست نشان دهد‬

16. List 2-3 persons, not your blood/distant relative, who are well familiar with your character, qualifications, personal
qualities and competence, whom we may contact as and when appropriate:

‫ اهليت و شايستگی شما‬،‫لطفا از سه نفر نام ببرید که در سه محل کاری مختلف سوپروایزهای شما بوده که با شما رشته نصبی ي ا ازدواجی نداشته باشندولی با کرکتر‬
‫ آشنای کامل داشته باشد تا عندالزوم به آنها منحيث رفرنس مراجعه نمائيم‬.
Name ‫نام‬ Business or occupation ‫وظيفه‬ Email Address ‫ اّدرس‬Phone # ‫تيليفون‬
‫ایمیل‬
1- Dr Moien Ansari 0795066295
MHT Team Leader ( BRAC ) moienansari68@gmail.com
2- Dr Aref Provincial Health Supervisor 0791802219
 Frahmand At Brace Organization

3- Razeq sidiqi Senior Area Officer AKF-A raziq.sidiqi@akdn.org

I certify that the statements made by me in response to the foregoing questions are true, complete and
Correct to the best of my knowledge and belief. I understood that any misrepresentation or false information provided on
this Application Form or any other document(s) submitted to CARE Afghanistan renders me to immediate dismissal.

‫ من ميفهمم‬.‫ مکمل و صحيح ميباشد‬,‫تصديق ميدارم معلوماتيکه در جواب به سواالت مندرج اين فورمه ارايه نموده ام تا جايکه به بصيرت و يقين من تعلق دارد درست‬
‫که معلومات نا درستيکه در اين فورمه يا در اسناد ديگرکه من انرا به کی ير تقدي م نموده باشم ظاهر گردد موجب عزل فوری من از کار با کی ير ميگردد‬.

Signature:______________________________________ ‫ امضاء‬Date:_____05/30/2023_______________________‫تاريخ‬:

Note: Please also attach your update CV and letter of interest with this Application form
.‫لطفآ بیوگرافی جدید ونامه وجه عال قـمندی تا نرا به این پست ضم این فـورمه نمائید‬