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HR-02-1420 Biodata Template Blank

This document contains a contractor employee biographical data sheet for an individual working under a USAID contract. It requests basic personal information such as name, address, citizenship status, and details of the proposed position including salary, contract number, and assignment duration. Educational history and language proficiencies are also required, along with employment history listing positions, dates, and annual salaries. The contractor and employee must certify that the provided information is accurate.

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Nourelhoda Adeel
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476 views2 pages

HR-02-1420 Biodata Template Blank

This document contains a contractor employee biographical data sheet for an individual working under a USAID contract. It requests basic personal information such as name, address, citizenship status, and details of the proposed position including salary, contract number, and assignment duration. Educational history and language proficiencies are also required, along with employment history listing positions, dates, and annual salaries. The contractor and employee must certify that the provided information is accurate.

Uploaded by

Nourelhoda Adeel
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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OMB Control No.

0412-0520; Expiration Date: 05/31/95


CONTRACTOR EMPLOYEE BIOGRAPHICAL DATA SHEET
1. Name (Last, First, Middle) 2. Contractor's Name
Creative Associates International
3. Employee's Address (include Zip Code) 4. Contract Number 5. Position Under Contract
EDH-I-00-05-00029-00
6. Proposed Salary 7. Duration of Assignment

8. Telephone Number (include area code) 9. Place of Birth 10. Citizenship (if non-U.S. citizen, give visa status)

11. Names, Ages, and Relationship of Dependents to Accompany Individual to Country of Assignment

12. EDUCATION (include all college or university degrees) 13. LANGUAGE PROFICIENCY
(see instructions on reverse)

NAME AND LOCATION OF INSTITUTION MAJOR DEGREE DATE LANGUAGE Speaking Reading

14. EMPLOYMENT HISTORY


1. Give last three (3) years. List salaries separately for each year. Continue on separate sheet of paper if required to list all employment related
to duties of proposed assignment.
2. Salary definition - basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions, consultant fees,
extra or overtime work payments, overseas differential, or quarters, cost of living or dependent education allowances.
POSITION TITLE EMPLOYER' S NAME AND ADDRESS Dates of Employment (M/D/Y) Annual Salary
POINT OF CONTACT & TELEPHONE #
From To EGP

15. SPECIFIC CONSULTANT SERVICES (give last three (3) years)


SERVICES PERFORMED EMPLOYER' S NAME AND ADDRESS Dates of Employment (M/D/Y) Days Daily Rate in
POINT OF CONTACT & TELEPHONE # at Rate EGP
From To

16. CERTIFICATION: To the best of my knowledge, the above facts as stated are true and correct
Signature of Employee Date

17. CONTRACTOR'S CERTIFICATION (To be signed by responsible representative of Contractor)


Contractor certifies in submitting this form that it has taken reasonable steps (in accordance with sound business practices) to verify the
information contained in this form. Contractor understands that USAID may rely on the accuracy of such information in negotiating and
reimbursing personnel under this contract. The making of certifications that are false, fictitious, or fraudulent, or that are based on inadequately
verified information, may result in appropriate remedial action by USAID, taking into consideration all of the pertinent facts and circumstances,
ranging from refund claims to criminal prosecution.
Signature of Contractor's Representative Date
AID 1420-17 (9/94)
INSTRUCTIONS

Indicate your language proficiency in block 13 using the following numeric Interagency Language Roundtable levels
(Foreign Service Institute levels). Also, the following provides brief descriptions of proficiency levels 2, 3, 4, and 5. 'S'
indicates speaking ability and 'R' indicates reading ability. For more indepth description of the levels refer to USAID
Handbook 28.

2. Limited working proficiency

S Able to satisfy routine social demands and limited work requirements

R Sufficient comprehension to read simple, authentic written material in a form equivalent to usual printing or
transcript on familiar subjects.

3. General professional proficiency

S Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most
formal and informal conversations.

R Able to read within a normal range of speed and with almost complete comprehension.

4. Advanced professional proficiency

S Able to use the language fluently and accurately on all levels.

R Nearly native ability to read and understand extremely difficult or abstract prose, colloquialisms and slang.

5. Functional native proficiency

S Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker.

R Reading proficiency is functionally equivalent to that of the well-educated native reader.


PAPERWORK REDUCTION ACT INFORMATION
The information requested by this form is necessary for prudent management and administration of public funds under
USAID contracts. The information helps USAID estimate overseas logistic support and allowances; the educational
information provides an indication of qualifications; the salary information is used as a means of cost monitoring and to
help determine reasonableness of proposed salary.
PAPERWORK REDUCTION ACT NOTICE
Public reporting burden for this collection of information is estimated to average thirty minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to:

United States Agency for International Development


Procurement Policy Division (M/OP/P)
Washington, DC 20523-1435;

and

Office of Management and Budget


Paperwork Reduction Project (0412-0520)
Washington, DC 20503
AID 1420-17 (9/94) Back

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