UNITED NATIONS		NATIONS UNIES	
UNIC Prague Internship Programme Application Form	
Please print clearly, preferably typed

PART I 
1. Applicant information: 
Family name (surname):	Present Address:	
First name (given name):		
Middle initial:		
Gender (sex):		
Date of Birth (day/month/year):		
Present nationality:	Nationality at birth:	
City / Country of birth:	Telephone:	
Fax:	e-mail:	
2. Emergency contact information: 
In case of emergency, notify:	Address:	
Family name (surname) and First name (given name):		
Gender (sex):		
Relations:		
e-mail:
Telephone:		Fax:		
I hereby confirm that I hold a health/accident insurance policy with the following insurance company:	
company name:	
Policy Number:	

3. Higher education (college/university) information:

Full title of the degree:	Degree expected (m/y):

Study started (m/y):	Main course of study:	
University name:	City:	Country	
Full title of the degree:	Degree expected (m/y):

Study started (m/y):	Main course of study:	
University name:	City:	Country	
Full title of the degree:	Degree obtained (m/y):

Study started (m/y):	Main course of study:	
University name:	City:	Country	

4. Internship information 
Knowledge of Languages:	Read	Write	Speak	
	Easily	Not Easily	Easily	Not Easily	Easily	Not Easily	
Czech:	__	__	__	__	__	__	
English:	__	__	__	__	__	__	
Other
(please specify):	__	__	__	__	__	__	

Computer skills:	
___Wordprocessing	___Internet research	___Spreadsheet	___Database	___Web page design	
Previous employment experience (use additional sheet if necessary):

	
Preferred work assignment: Please indicate the preferable area in which you would like to be considered for an internship.	
Public Information	__	Library work	__	

Other relevant information:	No	Yes
(Date)	
1. Have you ever applied for regular employment with the Untied Nations? If yes, please give dates	__	__	
2. Have you ever been arrested, indicted, or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned for the violation of any law (excluding minor traffic violations)? If yes, please explain and attach the release document from the authority.	__	__	
You may be requested to supply documentary evidence which supports the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so by UNIC and, in any event, do not submit the original texts of references or testimonials unless they have been obtained for the sole use of the Organization.

I certify that the statements made by me in answer of the foregoing questions are true, complete and correct to the best of my knowledge and belief. 

Date:						Signature:	

PART II 
To Be Completed By The Nominating Institution 
Please write clearly preferably typed. 
Name and Address of Nominating Institution/Organization:
(Must be stamped with the official seal)

	
Name of Certifying Official: (Print the name please)

Date:	Signature:	

 Send to: 
National Information Officer, United Nations Information Centre Prague, 
Železná 24, 110 00 Praha 1, Czech Republic
e-mail: info@osn.cz, fax: +420 257 316 761, phone: +420 255 711 645