OIE APPLICATION FOR INTERNSHIP

AP PLI CA TIO N FO RM
(please type or write in block capitals in BLACK ink)
1. Surname (1)

Forenames

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2. Full current address for correspondence
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Telephone

Fax

Email

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3. Date and place of birth ....................................................................................................................................................
4. Sex

{ male

{ female

5. Present nationality (if dual, state both)

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6. KNOWLEDGE OF LANGUAGES
Number the boxes as follows:
1 Excellent,
2 Good,
3 Basic working knowledge.
English

French

Spanish

Other (s) (please specify)

7. EDUCATION (attach photocopies of certificates)

A. Higher education (Undergraduate/graduate Level)
Name and address of establishment
(city, country)
from

Years of study
to (2)

Degree or diploma obtained; state class. State

official duration of course and main subjects

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B. Postgraduate education
Name and address of establishment
(city, country)

Years of study
from

Qualification obtained
to (2)

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8. Computer skills:

(1) IMPORTANT: Your application will be registered under this name. Please use it in all correspondence. Any other name (e.g. maiden name)

appearing on diplomas or certificates accompanying this application should be given here:

(2) Date of award of diploma etc. (month, year).

9. Published works:
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10. Have you any dependants?
If so, please give the following details:
Name

YES

Date of birth

Relationship

NO

Name

Date of birth

Relation ship

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11. Previous employment and in-service training/internsyhip periods
Employer

from

To

Nature of work

Net monthly salary

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12. References: Please give the names and addresses of three persons to whom you are not related and who are able to give a
character reference and who know your qualifications.
Full name

Full address (Telephone number if known)

Occupation

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13. Please provide on two separate sheets evidence of endorsement (OIE Delegate, Reference Laboratory or Collaborating
Centre) and sponsorship.
14. Requested internship: Tat OIE Headquarters

Tat an OIE Regional Representation (please state which one)

15. Using a separate sheet, please explain briefly (about 100 words) your reasons for applying for an internship at the OIE.

Copies of graduation diplomas and other certificates must be attached to this form, which is to be returned, duly completed and
signed, to the following address:
Head, Administrative and Financial Department
OFFICE INTERNATIONAL DES EPIZOOTIES
12 rue de Prony 75017 Paris France
fax: 33 (01) 42 67 09 87 administrative.dept@oie.int

I, the undersigned, declare that the information provided above is, to my knowledge, true and complete.
I realise that any false statement or omission, even if unintended on my part, may lead to the cancellation of my application.

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(Date)

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(Signature)

Office international des pizooties 12, rue de Prony 75017 Paris France
Tel.: 33 (0)1 44 15 18 88 Fax: 33 (0)1 42 67 09 87 www.oie.int oie@oie.int