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New Staff Entry Assessment Form

This document is a new staff entry assessment form for an Automation Engineer applicant named Semitagato Willy. It requests biographical information, references, language proficiency, availability to start, and confirmation that all information provided is true. If offered the position, Willy can commence duties on July 24th, 2023 and has not been arrested or convicted of any crimes. The form collects the necessary details to evaluate Willy's application for a new staff position.

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Ezekiel Natan Dalton
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214 views2 pages

New Staff Entry Assessment Form

This document is a new staff entry assessment form for an Automation Engineer applicant named Semitagato Willy. It requests biographical information, references, language proficiency, availability to start, and confirmation that all information provided is true. If offered the position, Willy can commence duties on July 24th, 2023 and has not been arrested or convicted of any crimes. The form collects the necessary details to evaluate Willy's application for a new staff position.

Uploaded by

Ezekiel Natan Dalton
Copyright
© © All Rights Reserved
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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New staff Entry Assessment Form

INSTRUCTIONS

Please answer each question clearly and completely.


To tick ‘yes or no’ double click on the box and select check
box on the dialog box and click OK

Surname :WILLY Title :AUTOMATION ENGINEER

Other names: SEMITAGATO

Address Tel: (home) 00257 61505556

Tel: (mobile) 00257 61505556

Tel: (work) 00257 61505556

(Discretion will be used if we contact you at work)

Do you require a work permit? : Yes No Fax/email [email protected]

References
Please give the name and address of two referees. One should be your most recent work colleague.

Name NTAWUYAMARA CLOVIS Name MIDOGORO JEAN CLAUDE

Position C.E.O. Position HEAD OF LOGISTICS

Organisation TICLO S.A. Organisation SAVONOR S.A.

Address 14, Avenue du Commerce, Bujumbura Address 1, Avenue d’Uvira, Q. Industriel, Bujumbura

Telephone 00257 79598865 Telephone 00257 69988073

Email Email [email protected]


May we contact this referee: May we contact this referee:
prior to your offer? Yes No prior to your offer? Yes No
prior to your interview? Yes No prior to your interview? Yes No

Service with UN might require assignment to any area of the world we have responsibilities.
(a) Are there any limitations on your ability to perform in your prospective field of work? YES NO
(b) Are there any limitations on your ability to engage in all travel? YES NO
.
Do you have any dependent children? YES NO If the answer is “yes”, give the following information:

Name of child Date of Birth

1.
2.

Languages – written and spoken

Written Spoken
level of fluency level of fluency

1. English Basic Advanced Basic Advanced

2. Kiswahili Basic Advanced Basic Advanced

3. French Basic Advanced Basic Advanced

4. Arabic Basic Advanced Basic Advanced

1. Do you have an International Dynamic Psychometric Exponential Logical Objective Mean Score (IDPELOMS) from an
independent invigilator YES NO

2. If yes, what was your total score ……………94………….. ( Please fill below the Name & Contacts of Psychometric
IDPELOMS Invigilators)

3. Name………Cendrov Associates……… Telephone …..……………………………… email………………


[email protected]…………………………………………..

4. If NO to (2) above, can you get certified within 24hours from an approved IDPELOMS certification centre YES
NO

If offered the position how soon can you commence your duties (specify the date)………July 24th, 2023…………

HAVE YOU EVER BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL
PROCEEDING, OR CONVICTED, FINED OR IMPRISONED FOR THE VIOLATION OF ANY LAW (excluding minor traffic
violations)? YES NO

I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be
sufficient cause for rejection or, if employed, dismissal.
The information you provide on this form will only be used in accordance with the principles of our confidentiality policy. If you are
appointed, it will form the basis of your personal record.

Full Names: SEMITAGATO WILLY Date July 13th, 2023

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