UNIUNEA EUROPEANA

Ministerul Administratiei si Internelor

Ministerul Administratiei si Internelor

Proiect finantat de
UNIUNEA EUROPEANA

Directia Schengen

Oficiul Roman pentru Imigrari

JRS Romania

Organizatia Salvati Copiii ERF/10.01/02.01

A 1. Activiti de asisten direct

Nr. dosar ______________

Subactivitatea
A 1.1. Identificarea beneficiarilor

A 1.2. Evaluare nevoi

FIA PERSONAL DE INTERVIU (ADULT)

Date generale
Nume i prenume ______________________________________________________________________
Data naterii /...../...../........../ ara de origine ________________________________________________
Statut: Refugiat Recunoscut (RR)

Protecie Subsidiara (PS)

Nr. i seria document identitate _________________________________________________________________

Stare civil: cstorit() / necstorit() / divorat() / vduv()

Telefon____________________

Adresa actual_______________________________________________________________________________
Nr. membri de familie __________ (data nasterii si statut):
So/Soie_________________________________/.../.../....../ RR / PS / strin / cetean romn
Minori aflai n ntreinere:
1)_____________________________________ /.../.../......./ RR / PS / strin / cetean romn
2)_____________________________________ /.../.../....../ RR / PS / strin / cetean romn
3)_____________________________________ /.../.../....../ RR / PS strin / cetean romn
4)_____________________________________ /.../.../....../ RR / PS / strin / cetean romn
Participare la Programul de integrare al O.R.I.
Nu a participat
A partipat (parial / finalizat )

Particip n prezent

Educaie
Studii / coli absolvite (nr. clase)_______________________________________________________________
Documente doveditoare _____________________________________________________________________
Loc de munc
Salariat da / nu Contract de munc da / nu Alt form de munc ____________________________
__________________________________________________________________________________________
Loc de munc actual________________________________

Domeniu_______________________________

Funcie/ocupaie______________________ Program de lucru______________ Contract de munc da / nu

Calificare / experiena profesional __________________________________
Venituri i / sau beneficii sociale
Beneficii sociale _____________________________________________________________________________

Alte venituri ________________________________________________________________________________

Cursuri de fomare profesionale
Competene profesionale_______________________________________________________________________
___________________________________________________________________________________________
Cursuri de formare profesional / vocaionale (domeniu)_____________________________________________
___________________________________________________________________________________________
Curs 1 ____________________________________ Curs 2___________________________________________
Diplome recunoscute__________________________________________________________________________
Orientare profesional_________________________________________________________________________
___________________________________________________________________________________________
Locuina
nchiriat / Servicii sociale / Comodat / Propietate persoanal / Alt form ______________________
___________________________________________________________________________________________
Nevoia de a accesa o locuin___________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Servicii medicale
Stare de sntate actual_______________________________________________________________________
___________________________________________________________________________________________
Boli cronice_________________________________________________________________________________
Alte nevoi care necesit asisten medical________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Asigurare medical da / nu

Medic de familie da / nu

Asisten social

Ajutoare sociale _____________________________________________________________________

Venituri pentru asigurarea hranei ________________________________________________________________
___________________________________________________________________________________________
Alte nevoi exprimate de beneficiar_______________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Cunoaterea limbii romne
Vorbitor de limba romn: da / nu
Cursuri de limba romn urmate da / nu /
Permis de edere i/sau cetenia romn

Nivel (nr. clase) _______________________________

Nevoia exprimat de beneficiar_________________________________________________________________

__________________________________________________________________________________________
Via social i cultural
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Traducere/interpretare
Nevoia exprimat de beneficiar_________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Observaii generale _________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Recomandri generale (evaluarea gradului de vulnerabilitate)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Organizatia Salvai Copiii
Consilier pentru tineret
_____________________________
(nume si prenume)
_________________________
(semnatura)
Data /...../...../......../
Locul
Centrul Regional ________________________
Birourile JRS Romania ___________________
Birourile OSC __________________________
O copie a documentului(lor) de identitate a(u) fost ataat(e)
(Datele completate n fia de interviu sunt cele declarate de beneficiar