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* Information with one asterix you have to fill out

** Information with two asterix will not be used as part of the selection process, but will help to determine how best to match people, skills and placements.

Name*

First name Last name

Address*

Address City Zip-code

Permanent address (if different)

Adresselinje By Zip-code

Telephone/mobile number*

Email*

Date and place of birth**

Gender*

Nationality*

Passport number*

Date and place of issue*

Expiry date*

Emergency

In case of emergency, who should be notified?

Name*

First name Last name

Address*

Address City Zip-code

Telephone/Mobile number*

Email emergency

Language*

Relationship to you*

Family situation

Please describe briefly your present family situation (i.e. do you have a partner/ children/other dependents)*

Education

Please give dates of attendance at schools and colleges

Secondary school*

College / University (please include name of collge/university and field of study)*

Other training and/or qualifications*

Have you ever participated in nonviolence training? If yes, please specify**

Do you have specialized training in Human Rights and/or International Humanitarian Law? If yes, please specify**

Work Experience

Please give details of your work experience starting with your present/most recent employment

Work Experience

Volunteer Experience

Please give details of any volunteer work

Volunteer Experience

Knowledge of Israel-Palestine

Please tell us about your knowledge of Israel-Palestine

Have you visited Israel and/or Palestine before and if so, for what purpose?

Please write a paragraph (not more than 250 words) to summarize your understanding of the current situation in Israel-Palestine*

Knowledge of Languages

Please tell us about your language knowledge

Mother tongue*

Please indicate your level of proficiency in each language by ticking the appropriate box and give details of any other languages you know

English (spoken)*

English (written)*

Arabic (spoken)**

Hebrew (spoken)**

French**

German**

Other languages and levels for these**

Anything else regarding languages you would like to comment on

Technological literacy

Please give your level of competence with computers, mobile phones and digital cameras

Use of a mobile phone*

– Updating phone book*

– Writing and receiving messages*

– Listening to voice mail*

Use of a digital camera*

– Taking pictures*

– Downloading pictures to the computer*

Use of a video camera*

Use of a computer*

– Microsoft Word*

– Microsoft Excel*

– Microsoft PowerPoint*

– Saving pictures on CDs*

Use of the Internet*

Ability to use e-mail programs including attaching documents and pictures*

Any additional skills and levels for these

Exposure to other cultures and faiths

Have you travelled, lived or worked in any other country/ies? – If yes, please give dates and details

Have you had exposure to people of other faiths and cultures? – Please give details

Experience of writing and research

Writing articles for publication is a requirement for the programme. Please give brief details of any reports or articles you have written with dates and purpose

Reports or articles you have written*

Active involvement

Do you belong to any church-related, ecumenical, faith-based or other civil society networks? – Please give details*

Advocacy work

Please give details of your experience of public speaking or other communication work*

Which of the above mentioned networks can assist in your advocacy work during and after your participation in the EAPPI?

Team work

EAPPI expects participants to live and work closely in teams with people of different countries, age, gender, and background

Please give examples of the teams that you have been part of. What roles have you taken within these teams and what did you learn from this experience?*

How do you feel about sharing a bedroom with another person for three months?*

Motivation

Please write a few paragraphs (not more than 400 words) on why you are applying for the post of an Ecumenical Accompanier*

Referees

Please give the names of three referees (NOT relatives) who have known you for at least one year

Name of 1. referee*

First Name Last Name

Phone of 1. referee*

How you know him/her*

Name of 2. referee*

First Name Last Name

Phone of 2. referee*

How you know him/her*

Name of 3. referee*

First Name Last Name

Phone of 3. referee*

How you know him/her*

Health

Please note that this section on your health is integral part of the assessment procedure. It will also help to determine which placement is most suitable in case you need any medical treatment while in Israel-Palestine. Please make sure you answer both questions carefully. Providing misleading information about your health may lead to the discontinuation of your term as an Ecumenical Accompanier.

Do you have any special dietary requirements? – If yes, please give details*

Do you, or others, consider that you have or have had any illnesses (physical or mental), other health issues, disabilities, cognitive, behavioural or mobility problems? – If yes, please give details*

Feedback

Please tell us how you found out about EAPPI*

Declaration

Name of applicant*

First name Last name

Date*

Day/month/year

Comments

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