Expected Salary for This Position (Minimum): USD$______

VISIONFUND (CAMBODIA) LTD

Employment Application Form Recent Photo 4 x 6 Building# 398, Preah Monivong Blvd., Sangkat Boeng Keng Kang1, Khan Chamkarmon, Phnom Penh, Cammbodia. . E-mail Address: [email protected] Tel:(855) 089-333-767

Position Applied for:………………………………………………..…………………..… Base in:………..………………………...…

Expected salary for this position (minimum): USD$______

1- PERSONAL DATA:

Name(in Khmer) ………………………………..…………………...………Name (in English):: ………………………………..………………Sex: ………

Date of Birth: …………………………………………Nationality: ……….….………National ID Card Number:......

Issue by:......

Place of Birth: ……………………….……………………...………………………………………………………………………………………………………………………

Permanent Address: ……………………………………………………………..………………………………………..………………… ………………………………… …………………………………………………………………………………………………………………………………………………………………………..…………………

Contact Address: ……………………………………………………………………………………………………..………………..……………………....………………… ………………………………………………………………………………………………………………………………………………………………………….……….…………

Telephone Number:………………………………………………………………… E-mail: .………………………………………………………………...…………….

In case of emergency, please notify:

Name:………………………………………..………..… Relationship: ………………………………………….……..………..…Tel: …………………………………..

Family:

Marital status: Single  Married  Widow / Widower 

Father Name: ……………………………………………….…… Occupation: …………………..…………………………………………………………………….

Mother Name: ………………………...……………………….… Occupation: …………………..…………………………………………………………………….

Spouse’s Name: ………………………………………………… Occupation: …………………..…………………………………………………………………….

Number of Children: ……….

2- EDUCATION: (Please list the latest first)

Attended Have you Name of School/University graduated? Degree Obtained Specialized Skill Location (city & country) From To (Y=yes, N=No)

 Y or  N

VisionFund Cambodia Revision date: August 17, 2012  Y or  N

 Y or  N

3- OTHER TRAINING: (List any training related to the position) Date Completed Name of Institution/ Center, Location (city & country) Training Course Duration (mm/yyyy)

4- LANGUAGE SKILLS: ( Poor - Fair - Averages - Good - Excellent)

Language Speaking Writing Listening Reading

5- SPECIAL INTERESTS: Hobbies or Activities ………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………………………………………….………………………………. …………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………….…………

6- EMPLOYMENT:

List past three (3) employers or voluntary assignments beginning with the most recent. Provide as much detail as possible. Employment Date Base Salary Other Compensation Name of Organization/Company 1 Month/ Year (U.S. Dollars) (Overtime, Commission, etc.)

From: ………………...………. Start:………….….... / Month. …………………………….………

To: ………………...……..……. Ending:………..….. / Month. …………………………….………

Company’s Main Business: ...……………………………………………………..………………………………………….………………………………………………

Office Address: ……………………..……………………………………………………………………………………………………...………………………………………

Office Contact Number: ……..…………………………………………………………………………………………………………………………………………………

Position(s) (Title) Held: …………………………………...………………………………………….…………………………………………………………………………

Describe your duties: ………………………………………………………………………………………………………………………………………………………....… …………………. …………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………….……………………………………………………………….

VisionFund Cambodia Revision date: August 17, 2012 …………………………………………………………………………………………………………………………………………………………………………………………… ………………..………… Direct Supervisor’s Name: …………………………………………… Supervisor’s Title: ……………….……………………… Tel: …………………………

Reason for Leaving: …...……………………………………..…………………….…………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………….…………………….……………… Employment Date Base Salary Other Compensation Name of Organization/Company 2 Month/ Year (U.S. Dollars) (Overtime, Commission, etc.)

From: ………………...………. Start:………….….... / Month. …………………………….………

To: ………………...……..……. Ending:………..….. / Month. …………………………….………

Office Address: ……………………..……………………………………………………………………………………………………...………………………………………

Describe your duties: ………………………………………………………………………………………………………………………………………………………....… …………………. …………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………….………………………………………………………………. …………………………………………………………………………………………………………………………………………………………………………………………… ………………..………… Direct Supervisor’s Name: …………………………………………… Supervisor’s Title: ……………….……………………… Tel: …………………………

Reason for Leaving: …...……………………………………..…………………….…………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………….…………………….……………… Employment Date Base Salary Other Compensation Name of Organization/Company 3 Month/ Year (U.S. Dollars) (Overtime, Commission, etc.)

From: ………………...………. Start:………….….... / Month. …………………………….………

To: ………………...……..……. Ending:………..….. / Month. …………………………….………

Office Address: ……………………..……………………………………………………………………………………………………...………………………………………

Describe your duties: ………………………………………………………………………………………………………………………………………………………....… …………………. …………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………….………………………………………………………………. …………………………………………………………………………………………………………………………………………………………………………………………… ………………..………… Direct Supervisor’s Name: …………………………………………… Supervisor’s Title: ……………….……………………… Tel: …………………………

Reason for Leaving: …...……………………………………..…………………….…………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………….…………………….……………… 7- ADDITIONAL QUESTIONS:

a). Please provide 3 top sources of job announcement that you usually visit?

- Newspapers, - Websites, -VisionFund’s announcement board, -University’s announcement board

- Friends, - others, specify……………………………………………………………………………………………………………………….....

b). Do you have any close friends or relatives employed by VisionFund Cambodia? Yes  No 

VisionFund Cambodia Revision date: August 17, 2012 If Yes, give Name, Position, Department/Branch, and your relationship with him:

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c). What is the poverty situation in Cambodia?

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d). How is your current social involvement in Cambodia?

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e). What do you know about microfinance?

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f). What do you know about VisionFund Cambodia?

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g). VisionFund Cambodia is a Christian microfinance institution. How do you feel working in a Christian environment?

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VisionFund Cambodia Revision date: August 17, 2012 h). Describe and explain child’s right.

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8- REFERENCE:

List those familiar with your capabilities in addition to the supervisors previously noted under employment (do not list

relatives).

VisionFund Cambodia Revision date: August 17, 2012 Name: …………………………… Job Title/ Mobile Phone Comp ……………………………………… any:

Address Relationship

Name: …………………………… Job Title/ Mobile Phone Comp ……………………………………… any:

I authorize the referees listed above to provide VisionFund Cambodia any and all information concerning my previous

employment and any pertinent information that they may have.

To the best of my knowledge, the answers to all of the questions contained herein are true and correct, and I have not

knowingly withheld any information which might in any way affect this application. I understand that any misstatements or omissions of material facts in this application may be cause for dismissal.

Applicant’s Signature: ………………………………………………………. Date: ………………..……………………..……

VisionFund Cambodia Revision date: August 17, 2012