PAMOJA INTERNATIONAL VOLUNTARY SERVICES 2009 APPLICATION FORM FOR

							              PAMOJA INTERNATIONAL VOLUNTARY SERVICES 2009

       APPLICATION FORM FOR MEDIUM AND LONG TERM VOLUNTEERS


Names of projects you are applying for:

First Choice:
_______________________________________________________________________

Second Choice:
_____________________________________________________________________

1. Your Name:
___________________________________________________________________

2. PERMANENT HOME ADDRESS:

City: __________________________

Country: _______________________________________

Telephone: _______________________________

E-mail: ___________________________________

PRESENT ADDRESS:

________________________________________________________________________

________________________________________________________________________

3. Nationality: ________________________________

Date of birth: ____ / _____ / _____

Sex: ___________

Country of birth: ______________________

Town of birth: ___________________

Passport No or I.D No: ___________________

Blood Group: ___________________




e: midlongterm@pamoja.co.ke
www.pamoja-international.org
Marital Status: ___________________



4. Contacts in Case of Emergency

Name: ___________________

Telephone: ___________________

Email: ___________________

5. Date you are available for voluntary service:

From: _____ / _____ / _____ to _____ / _____ / _____

How long do you want to serve (minimum) _________________              (maximum)
________________

6. How do you want to spend your free time?
______________________________________________

________________________________________________________________________

________________________________________________________________________

7. Fields of interest: (please tick the ones you are interested in)


             Education                                   Health


             Social Work                                 Office



8. Have you ever been a mid or long term volunteer with any organization?

________________________________________________________________________

________________________________________________________________________

9. Why do you want to be a medium term volunteer/ long term volunteer with PIVS?

________________________________________________________________________

________________________________________________________________________




e: midlongterm@pamoja.co.ke
www.pamoja-international.org
________________________________________________________________________

10. Present occupation/ studies/ training schemes following or completed

________________________________________________________________________

________________________________________________________________________

11. Previous work experience/ mid and long term volunteer experience (Paid or and voluntary
work)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

12. Languages:

Please write how well you can speak, read or write English and add other languages

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

13. Skills you would like to mention (such as practical, artistic domestic, intellectual etc, driving
license)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

14. Three references (no relatives)

Contact Name                Position            Organization               Address / E-mail

____________________ ______________ ____________________ ______________

____________________ ______________ ____________________ ______________

____________________ ______________ ____________________ ______________



e: midlongterm@pamoja.co.ke
www.pamoja-international.org
15. Any serious accidents, illnesses, handicap, allergies, mental problems or depressions? Specify

________________________________________________________________________

________________________________________________________________________

16. Are you already insured? __________________________

If so please specify
___________________________________________________________________

________________________________________________________________________

17. Experiences with communities (or other long term projects)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

18. Explain as fully as possible why you are applying for this voluntary service and what you
envisage both contributing and learning from the experience?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

19. How did you hear about the program?
_____________________________________________________

20. Please tell us anything you would like to add about yourself

________________________________________________________________________

________________________________________________________________________




e: midlongterm@pamoja.co.ke
www.pamoja-international.org
If you need more space for the above questions, please attach a separate piece of paper and
indicate which questions you are answering. Very often it is appreciated or required to attach a
letter of motivation as well. Please attach your Current photo and the first 2 pages of your
passport. Thank you.

       I would like to participate in the mid and long term volunteer program governed by
       PIVS. I acknowledge what I am supposed to do and whether there may be extra
       activities in the program that I apply for. I agree not to sue PIVS for any legal and
       financial damage and loss incurred during the program. I understand that I should
       pay for the insurance personally. Hereby, I agree to take any responsibility for any
       injure and damage incurred in the program, and to participate in any activity
       sincerely throughout the whole program.

And I accept the conditions of participation for the program by the host organizations

Date                             (applicant signature)




e: midlongterm@pamoja.co.ke
www.pamoja-international.org