International Citizen Service Programme ICS Programme Volunteer Application Form

Location: Kagera (Kamachumu, Buko a !ural " Karag#e$ )anuar* '+,Clo%ing &ate: '(

ICS Programme Volunteer . ,' #eek contract commencing ,+ th /arch '+,Volunteers will stay with host families and food and other daily expenses will be covered. Be0ore completing thi% application 0orm, plea%e make %ure that *ou are 0ul0il the 0ollo#ing criteria1

Succe%%0ul applicant% mu%t:

be Tanzanian citizens living in Kagera, Kigoma, Shinyanga or Mwanza Minimum secondary school up to !orm " with certificate or !orm # be aged $% to &' be able to communicate in (nglish or Swahili )(nglish is an added advantage* have been involved in community development through clubs, youth groups, community based organisations or volunteering be able to wor+ well in a team be able to commit to a full,time $&,wee+ programme away from home be available for training - wee+s before the programme starts.

.lease complete all sections of the application form clearly and accurately and return it by email to/ 01S .rogramme Manager, 0misa.Masin2ila3vsoint.org 2r by post to/ 01S .rogramme Manager, VS4 Tanzania, .lot 5o 667 Msasani, ..4 8ox #&67 9ar (s Salaam 9eadline/ ,3:++ Fri4a* '( )anuar* '+,0nterview 9ates/ ,%t " 'n4 Fe ruar* '+,-

9ue to anticipated interest in these posts, only short listed candidates will receive a response. The 01S .rogramme is committed to a policy of e<ual opportunity we wor+ to ensure that people are not un2ustifiably discriminated against on the basis of disability, ethnicity, gender, religion or beliefs, sexual orientation or any other irrelevant grounds. People living #ith 4i%a ilit* encourage4 to appl*.

01S .rogramme Volunteer :pplication !orm .age ; $

0f you have any <uestions, please call the 01S .rogramme Manager =&'' )>* && &#> >7&?%7 (xt $$$

Per%onal &etail%
5ame )!irst 5ame and !amily 5ame* Telephone number )number that you can easily be reached* (mail address )you must open an account if you do not have one* 9ate of 8irth (445mm5**$ )Ver* important* )Should 5ot more than &' @ears* Ahere are you fromB )Cegion?9istrict* Ahere do you liveB )Cegion?9istrict* AhatDs your 8lood Eroup Ahich secondary school did you attendB Ahat are you currently doingB Sex )!emale?Male*

Ahat is your highest level of educationB .lease describe :ny Fealth 1onditions, eg allergies, dietary etc. )5o one will be discriminated because of their health conditions* Fave you ever been involved in proceedings against you in either a civil or criminal courtB 0f @(S, please give details. :re you able to live away from home for ,' #eek% 0rom ,+th /arch '+,-B :re you available for interview during the wee+ of $st wee+ of Fe ruar* '+,- (,%t or 'n4 Fe ruar*$6 :re you available for 0nitial Training 1ourse on ,-th an4 ,(th Fe ruar* '+,-B

01S .rogramme Volunteer :pplication !orm .age ; &

78perience
.lease include any wor+ or voluntary experience you have had, starting with the most recent first. @ou can continue onto another page if you need to.

9ates Gob title and organisation !rom and to )dd?mm?yy* Cole and responsibilities )please describe*

/otivation Ahat s+ills will you be able to contribute to your voluntary wor+ in the communityB

01S .rogramme Volunteer :pplication !orm .age ; -

Ahy are you interested in applying for this volunteer positionB )Maximum ->> words*.

!e0eree%
:s part of the selection process 01S would li+e to spea+ to two referees, who are able to provide character references for you. Ceferees will be contacted after the interview stage.

Ceferees can be teachers, employers, volunteer supervisors, local government representatives etc. Ceferees CA992: be mem er% o0 *our 0amil* or 0rien4%. @our ne8t o0 kin %houl4 e %omeone clo%e to *ou, inclu4ing 0amil* mem er%

01S .rogramme Volunteer :pplication !orm .age ; "

!e0eree , 5ame )!irst 5ame and !amily 5ame* .osition 4rganisation?0nstitution Celationship to you .hone number !e0eree ' 5ame )!irst 5ame and !amily 5ame* .osition 4rganisation?0nstitution Celationship to you .hone number 9e8t o0 Kin (pre0era l* 0amil* mem er$ 5ame )!irst 5ame and !amily 5ame* Celationship to you Town where they live .ostal :dress .hone number

;our 4eclaration
0 declare that to the best of my +nowledge and belief the information given on this form is correct. Signature 5ame 9ate .lease do not send any additional certificates or documentation.

01S .rogramme Volunteer :pplication !orm .age ; '

01S .rogramme Volunteer :pplication !orm .age ; #