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Photograph

REPRODUCTIVE HEALTH ASSOCIATION OF CAMBODIA

4x6

BaksMubMerIkargar
APPLICATION FOR EMPLOYMENT

kardak;BaksMrab;m kmviFI Program: uxtMENg

Position applied for:

TIkEng
Location:

1.

RbvtirUbpal;xn Personal Data: eQaH Name: CaPasaExr

(Khmer Language)

ePT Sex: Rbus Male Female

National ID Card No:

RsI

CaPasaGg;eKs
( English Language)

GtsBaaNbN TIkEngkMeNIt Place sBaati Nationality:

of Birth:

Date of Birth: (dd/mm/yy)

fExqaMkMenIt fExqaM

Gasydanbcb,n Present Address:

elxTUrsBTelephone No: GIuEml E-mail:

sanPaBRKYsar Family : etIGkmanerobkar cMnYnkUnGken eQaHrbs;bIRbBn Spouses name: ehIybenA? Akgbnk CaPasaExr Are you married? No. of Children/Dependants: ( ) man Yes eT Rbus Male: No CaPasaGg;eKs ( ) RsI Female:
Khmer Language English Language

muxrbrrbs;bIRb TIkEngeFIVkarrbs;bIRbBn Spouses Employer/Organization: Bn

Spouses occupation:

kMritvb,Fm Formal Education: karsikSa qaMsikSa Years sBaabRt CMnajEdl)ansik Educational Institution Attended Sa eQaHTIRkuge Degree/Certificate Major Subjects of Study BI From dl; To Obtained xtRbeTs
2.
Name/City/Province/Country

3.

vKbNHbNalepSg Other Training Received: sabnTTYlvKbN fExqaMsik sBaab HbNal Sa Attended date Rt
Training Institution

eQaHnvKb NHbNal
Name of Training Course

eQaHTIRkuge xtRbeTs
Name/City/Province/Country

BI From

dl;

To

Obtained Certificate

4.

CMnajkMB Tr
Computer skills

Gt; l lN ec as; Good Very H Good

Dont Know

cMeNHdwgEpkPasa Language Ability: sUmdak;Binedayxngtamk MritdUcxageRkam minecH=1/ ecHtic=2/ ecH=3/ ecHsat;CMnaj=4

5. Please rate yourself according to the following scale: Poor=1, Fair=2, Good=3, Fluent=4

Microsoft Word Microsoft Excel Microsoft Access Power point

Pasa Language Exr Khmer Gg;eKs English )araMg French

2

niyay
Verbal

sresrWri
tten

Internet research

epSg sUmbBaak;
Other (please specify):

Database Web page design Other ( please specify)

cMNg;cMNUlcitBiess cMNUlciteBlTMenrbkarRbRBwtSpecial Interests (Hobbies or Activities):

6.

Rbvtikargar Employment History cUrerobrab;GMBIkEngkargarkngmkcMnYn 3kEngedaycab;epImBIkargarcugeRkayeKbMput

7.
(List past three (3) Employers, beginning with the most recent)
7.1

eQaHnigGasy ryeBlbMerIkarg R)ak;ebovtSn_ GtRbe danrbs;Ggkar ar dulashrdGae yaCn_e Employment period sabn mrik pSg
Organization/institution name & address Basic salary (US$)

BI From eTA To cab;epI bBab Exq Exq m Starting: ; Ending: aM(mm/ aM(mm/ ./ Ex month ./ Ex
yy) yy) month

Other compensation

muxtMENg Position
(s) Title held:

erobrab;Parkic TTYlxusRtUv
Describe your responsibilities/Tasks:

mUlehtunkarca kecjBIkargar
Reason for leaving:

7.2

eQaHnigGasy ryeBlbMerIkarg R)ak;ebovtSn_ GtRbe danrbs;Ggkar ar dulashrdGae yaCn_e Employment period sabn mrik pSg
Organization/institution name & address From

BI

To

eTA
3

Starting:

Basic salary (US$) Ending:

Other compensation

E xqa M
(mm/yy)

E xqa M
(mm/yy)

cab;epI bBab m ; ./month ./month Ex Ex

muxtMENg Position
(s) Title held:

erobrab;Parkic TTYlxusRtUv
Describe your responsibilities/Tasks:

mUlehtunkarca kecjBIkargar
Reason for leaving:

7.3

eQaHnigGasy ryeBlbMerIkarg R)ak;ebovtSn_ GtRbe danrbs;Ggkar ar dulashrdGae yaCn_e Employment period sabn mrik pSg
Organization/institution name & address

BI (mm/yy)E xqa M
From

eTA (mm/yy)E xqa M

To

Starting:

Basic salary (US$) Ending:

Other compensation

cab;epI bBab m ; ./month ./month Ex Ex

muxtMENg Position
(s) Title held:

erobrab;Parkic TTYlxusRtUv
Describe your responsibilities/Tasks:

mUlehtunkarca kecjBIkargar
Reason for leaving: 8.

sadsMerc)an RbsinebIman Professional Publications (if any):

9.

BtmanepSg Other information:

4

a.

etIGkFab;RtUv)anbBab;bBrBIkargarEdrbeT? Fab; Yes minFab; No

Have you ever been dismissed or suspended from employment?

RbsinebIFab; sUmbBaak;BImUlehtu If Yes, give reasons:

b.

etIGkmanmitPkiCitsiTbsac;jatiCabuKlikrbs;smaKmra:k; EdrbeT ? man Yes minman No

Do you have any close friends or relatives employed by RHAC?

RbsinebIman sUmbBaak;eQaH/ muxgar/ Epk nig TIkEngbMBjkargar If Yes, give Name, Position, Department, & project site: RbsinCaGkRtUv)aneRCIserIsCabuKliksmaKmra:k; etIeBlNaGkGaccab;epImkargar)an? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>
c. If selected for employment at RHAC, how soon will you be available to begin work?.............................................................................
10.

GkFana cUrerobrab;mnusScMnYn3nak;Edlsal;c,as;BIbuKliklkNnig smtPaBrbs;Gk.minRtUverobrab;BIsac;jatieLIy

References

eQaH Name Ggkar Organization muxtMENg Title elxTUrsB Telephone GIuEml E-mail

(List three persons who are familiar with your character and capabilities. Do not list relatives).

1. . 2. . 3. .
11.

sUmFanaGHGagfaral;cMelIyEdl )anbMeBjxagelIBitCaRtwmRtUv ehIyminmanlak;)aMgBtmanNamYyEdlCH\TiBldl;kardak;Bake nHeLIy.Rbsin CacMelIyxagelIminBitbmankarlak;)aMgBtmanNamYyenaH suxciteGayGgPaBbBab;BIkargar .

To the best of my knowledge, the answers to all of the questions listed above are true and correct, and I have not knowingly withheld any information which might affect this application in any way. I understand that any misstatements or omissions of material facts in this application may be cause for dismissal.

htelxarbs;ebkCn Signature of Applicant:. kalbriecT Date: .

12.