HTSPE LTD. CONSULTANT'S QUESTIONNAIRE 1.

CONTACT DETAILS TITLE (Dr/Mr/Mrs/Ms): GENDER: ADDRESS: MAIN ALTERNATE SURNAME/FAMILY NAME FIRST NAME/FORENAME

CITY AND POSTCODE COUNTRY 'PHONE NUMBER: MOBILE/CELL: EMAIL ADDRESS: FAX NUMBER: SKYPE ADDRESS:

2.

PERSONAL DETAILS

NATIONALITY: DATE OF BIRTH (dd/mm/yy):

3.

PROFILE Month/year

AVAILABILITY Date next available for work:

FEE RATE (based on 22 day working month, excluding subsistence + travel) Rate/month (indicate currency) Long-term (more than 3 months) Rate/day (indicate currency) Short-term (less than 3 months)

ASSIGNMENT PREFERENCE Region Long-term (more than 3 months) Short-term (less than 3 months)

PREVIOUS EXPERIENCE WITH HTSPE:

W = worked on HTSPE project N = nominated in HTSPE bid

YEAR OF FIRST RELEVANT WORK EXPERIENCE: SPECIFIC EXPERTISE Team Leader Experience Policy Experience Yes/no Yes/no

PERMISSION TO USE YOUR CV

I agree to HTSPE sharing my CV with the HTSPE branch offices overseas.

* HTSPE is required, by data protection legislation, to receive your authorisation before sending your CV outside the EU.

I agree to HTSPE including my CV in Expressions of Interest/Prequalifications without my prior approval (except where EoIs/PQs require exclusivity)
* This is to prevent missed opportunities caused by short submission deadlines. Please be assured that the inclusion of your CV in an EoI/PQ would imply no commitment on the part of the consultant or HTSPE and that we would always notify you once your CV had been included in an EoI.

4.

CAPABILITY (EDUCATION AND EXPERIENCE) Date Obtained

HIGHEST QUALIFICATION

DISCIPLINE OF HIGHEST QUALIFICATION (please choose one from attached List A*):

MAIN SPECIALISM (please choose TWO from attached List B*):

LANGUAGES
(1 = Mother tongue/fluent/excellent, 2 = very good, 3 = good, 4 = fair, 5 = basic)

Language

Skill Level

Language

Skill Level

5.

WORK EXPERIENCE RELEVANT PROJECT EXPERIENCE (please list countries where you have worked):

DONOR EXPERIENCE (please indicate which donors you have worked for): ADB AfDB AusAID Danida DFID EU FAO Finnida IADB IFAD SIDA UNDP USAID WB Others

Please refer to these lists to answer Question 4: *List A (Please Choose ONE Only) Discipline of Highest Qualification
o o o o o o ACCOUNTS BUSINESS DEVELOPMENT STUDIES ECONOMICS EDUCATION ENGINEERING Mechanical Civil Chemical Agricultural/Food Water/Sanitation Other ENVIRONMENT FINANCE HEALTH IT LANGUAGES LAW MEDICINE NATURAL RESOURCES OTHER HUMANITIES POLITICS/INTERNATIONAL RELATIONS SCIENCE Chemistry Physics Biology Other SOCIAL SCIENCES

**List B (Please Choose TWO Only) Specialisms

AGRICULTURE/FOOD INDUSTRY AQUATIC RESOURCES SOCIAL DEVELOPMENT SECURITY/JUSTICE EARTH OBSERVATION ECONOMICS EDUCATION AND TRAINING ENVIRONMENT FINANCE FORESTRY GENDER ISSUES INFORMATION SYSTEMS/MANAGEMENT GOVERNANCE HEALTH HUMAN RESOURCES AND EMPLOYMENT INSTITUTIONAL/ORGANISATIONAL DEVELOPMENT IT LAW LIVESTOCK MARKETING/MEDIA/COMMUNICATIONS MECHANICAL ENGINEERING M&E NATURAL RESOURCES MANAGEMENT PRIVATE SECTOR DEVELOPMENT PUBLIC ADMINISTRATION PUBLIC FINANCE RURAL DEVELOPMENT SMEs SURVEY/LAND ADMINISTRATION TOURISM TRADE URBAN PLANNING AND INFRASTRUCTURE OTHER

o o o o