Wide Horizons (WH)

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Application Form Please complete the form and submit to WH staff member on the day of your interview. If you need an application, please email widehorizonsmaesot@gmail.com 1. Personal Information

Name:

Date of Birth: Gender (circle 1): Male / Female Ethnicity:

Marital Status: Phone Number:

Email: Host Organization:

2. Documentation Please circle the following identification category that applies to you and attach a copy of the ID card/document to this application

a) UNHCR b) PRE registration c) 10 year ID d) Other

3. What is the highest Education level that you have completed? a) Primary b) high school c) Post-ten d) University 4. Computer skills (Note: You also need to take a short exam on computer knowledge, on the Testing Date)

How would you rate your computer skills? Please circle below.

a) Advanced b) Very good c) Good d) Basic e) Weak

5. Volunteer or Work Experience: Please provide detailed information of your present and past work/ volunteer experience in your community.

Current Organization

Start Date End Date

Job Title

Description of Duties

TestDate:______________________ (Date/Month/Year)

TestLocation:_________________________

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5. Volunteer or Work Experience Continued: Past Organization

Start Date End Date

Job Title

Description of Duties

6. Why are you applying for Wide Horizons School? What are your plans after your 1-year internship with your host organization? 7. Reference Please give the attached reference form to your supervisor at your current organization to complete about you. *Note: You cannot give this form to a parent, family member, or friend. သငယခလကရလပကငေနေသာအဖြ အစညးမ သငအၾကေပးအရာရအား သငႏငပတသကေသာအေၾကာငးအရာမားက ဤေထာကခစာ၌ ျဖညစြကေပးရန။

* သတေပးခက။ ဤေထာကခစာသည သငမဘ၊မသားစအဖြ ဝင (သ ) သငယခငး မျဖညစြကေပး၍မရႏငပါ။

Wide Horizons (WH)

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REFERENCEFORM(page1) ေထာကခစာပစ (စာမက ႏာ ၁)

Candidate name: ေလာကထားသအမည

Referee name/Title: ေထာကခ သအမည၊ရာထး

Organization: အဖြ အစညး

Contact Details: ေနရပလပ စာအျပည အစ

Please complete the following grid for this candidate. ေကးဇးျပ၍ေအာကေဖာျပပါဇယားတြငျဖညစြကေပးပါရန။ Excellent

အေကာငးဆ း Good ေကာငး

Average သင

Below average ည

Motivation to learn new things အေၾကာငးအရာ သစမားကေလလာရနစတအားထကသနျခငး

Critical Questioning Ability ေတြးေခၚရေသာေမးခြနးမားေမးႏငမႈ စြမးရည

Communication skills ဆကသြယေရးပငးဆငရာကၽြမးမႈ

Leadership potential ေခါငးေဆာငႏငမႈစြမးရည

Management (time, tasks) အခနႏငလပငနးစမခနခြမႈ

Persistence ၾကးပမးမႈ

Self-motivation စတပါဝငစားမႈ၊တကၾကြမႈ

Attitude and Enthusiasm ကယပငစြမးရညႏငစတေနသေဘာထား

Team work အတတကြပးေပါငးေဆာငရြကႏငမ

Interest in Community Work လမအသငးအဝငးလပငနး၌စတဝငစားမ

Commitment to Organization အဖြ အစညးအေပၚႏစျမပေပးဆပႏငမႈ

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REFERENCE FORM (page 2) ေထာကခစာပစ (စာမက ႏာ ၂)

Please comment about the candidate in detail: ေကးဇးျပ၍ေလာကထားသႏငပတသကေသာ အေၾကာငးအရာမားအား အေသးစတေဖာျပေပးပါရန။

Length of time working at organization: __________________________ အဖြ အစညး၌လပေဆာငမႈသကတမး

Current responsibilities at organization: ( အဖြ အစညး၌ယခလကရလပငနးတာဝန )

Strengths: ( အားသာခကမား ) Weaknesses: ( အားနညးခကမား ) What I hope the candidate will learn at WH: WH ေကာငး၌ေလာကထားသတစဦးသငယေလလာရမညကၽြႏပေမာလငထားေသာအရာမား

Intended responsibilities during internship year ( အလပသငႏစအတြငး ရညရြယထားေသာ လပေဆာငရမညတာဝနမား )

I _________________________ (your name), declare that I am the supervisor of __________________________ (candidate name), that our organization is willing for the candidate to attend WH for 10 months, and that we intend to have a job ready for the candidate when s/he returns for his/her internship at our organization in April.

ကၽြန ေတာ/ကၽြန မ______________________________(သင အမည) ကၽြန ေတာ/ကၽြန မသည___________________________(ေလာကထားသအမည) ၏အၾကေပးအရာရ ျဖစ ပါသည။ ကၽြန ေတာ/ကၽြန မတ အဖြ အစညးသညေလာကထား ထားသအားWH၌၁၀လပညာသငယရန သေဘာတညပါသည။ ဧပရယလ၊၂၀၁၅ခႏ စ ၌ ပညာေတာသငမ အဖြ ႔အစညးသ ႔ ျပန လညေရာကရ လာေသာအခါ ၄ငးအတြက အလပေနရာ (ရာထး) တစခ အဆငသင ရ ေနမည ျဖစ ေၾကာငး အာမခပါသည။ Signature (လကမတ):______________________ Date (ရကစ ြ ): _____________