Internal use only

FAMILY PLANNING ASSOCIATION OF NEPAL

Employee Application Form

Candidate
No.

GUIDELINES FOR FILLING THE APPLICATION FORM

Please complete the application form in black ink or electronically. If completing the application by
hand, please scan and send the complete and signed document to us by e-mail. If you are filling the form
electronically, you can directly e-mail the soft copy to the e-mail address given in the advert. In doing
so, it will be presumed that information you have provided is true and complete. If you are invited to
attend the interview process, you will be asked to sign the declaration page of your application on your
arrival.
FPAN is an equal opportunities employer and appoints on merit by open competition.
This form comprises an essential part of the selection process at FPAN. The information you provide
and the quality of your response is likely to have a significant impact on your being short-listed for the
interview process. Hence, please ensure that you fill the application form in as much detail as possible.
You may also choose to attach your CV but any other additional material will not be accepted.
Please ensure that the information provided by you in this form is complete, correct and accurate. Any
false statement or omission may render you liable to action, which may include disqualification of your
application. In case you are offered employment or are appointed, this may also lead to your
appointment being withdrawn or to your dismissal.
We appreciate concise information and hence, limited space is provided for the information to be
provided. However, if needed, please expand the tables and use additional sheets to include additional
information if required.
If your application is shortlisted, you will be invited for the interview process.

FAMILY PLANNING ASSOCIATION OF NEPAL

Employee Application Form

Position Applying for

: Monitoring and Evaluation Officer

Level/Grade

: 6th

Application Source

Division/Project

: Support for International

Family Planning
Organisation (SIFPO2)

Location/Base

: Kantipur Daily
Newspaper
: Bhojpur District

Personal Details
Full Name

Manis Verma

Fathers/Mothers/Spouses Name

Kahaniya lal Verma

Sex

Male

Nationality

Nepalese

Date of Birth

Special Identification marks

No any special identification marks on the my body.

Telephone
:
Mobile Number
: +977-9843052037
Khajura Khurd, VDC-2, Banke

Pepsicola, Kathmandu

(Spouse/Children/Parents) Note: Brothers/sisters/other

relations may NOT be included as family members

Age

Relationship with
Employee

E-mail Address:
Vermanish01@gmail.com
Permanent Address (District,
Municipality/VDC, Ward No)
Present Address (District,
Municipality/VDC, Ward No)
Family Members

Name

12/03/1990 A.D

Whether staying with

employee or Not
( Yes or No)

If you have worked with us before, please state

when and in what capacity.

Yes

No

Yes

No

If I get an opportunity to work with you, I

am welling to join Very fine day of my interview
with my full knowledge and skills.

Education Background
Please start with the most recent up to class ten, including any current studies.
Degree/Diploma/certifi
cate

Year of
Comple
tion

School/College/Instit
ute

Board/Universit
y/Institute

Subjects

Division/Ma
rks

Bachelors in Social
Work (BSW)

2013
A.D

Xavier
International College

Tribhuwan
University (TU)

English,
Nepali,
Method of
Social

49%/Secon
d Division

Work,
Social work
Research,
IOPsychology,
Juvenile
Delinquency
, Abnormal
Psychology,
Social Work
Administrati
on,
Integrated
Social
Work,
Developme
nt
Perspective
Social work
and
Research
Psychology
10+2, Science

2008

Jaya
Bageshwory Higher
Secondary School

HSEB
Board

Mathematic
s, Biology,
English,
Nepali

50%

SLC

2006

ABC Residential High

School

HMG

English,
Nepali,
Math

58%

(Please add additional rows to the table if required)

Training Exposure:
Include any job training, as well as formal training, that is relevant to the job for which you are applying.
Nature/Course or Description of Training

Organizing Agency

Year

Capacity Building on monitoring and Evaluation

Framework and its indicators

Transcultural
Psychosocial Organisation
Nepal

2016

Training on Focus Group Discussion Research

Transcultural
Psychosocial Organisation
Nepal

2016

Training on SPSS Software

Transcultural
Psychosocial Organisation
Nepal

2016

Training on Reality Check Approach Research

Foundation for Development

Management

2015

2012

FAMILY PLANNING ASSOCIATION OF NEPAL

Employee Application Form

Membership of Professional/Academic Associations

Name of Body

1st Registration date

Registration
No.

Renewal date

Awards/Prizes won:

Hobbies and Interest :

Socialising with friend and family, Plaining cricket and chess.

Skills
Languages Known: Please tick ()
Language

Read

Write

Speak

Understand

English

Nepali

Aawadhi

Hindi

(use additional sheets if required)

Computer skills: Please indicate your skill levels with tick () in the relevant column.
Software

Basic

Intermediate

Advanced

(use additional sheets if required)

Publications:

(use additional sheets if required)

Work Experience/ Employment History : From first Job onwards)

Current or most recent employment
Employers name and address

Your job title

Senior Monitoring and Evaluation

Assistant
Transcultural Psychosocial Organisation
(TPO) Nepal, Baluwatar, Kathmandu,
Nepal

Nature of Employers business

Employment Period
From (mm/yy)

10/2015

Employment Period
To (mm/yy)

10/2016

Notice period

November 24, 2015-July 30, 2016

Reasons for
leaving/seeking
change

Project Accomplished

NGO
Brief Description of Responsibilities & Achievements/Assignment Undertaken:

Updated and maintained database in coordination with project team.

Coordinating closely and on a daily basis with the program officer on all data collection,
data entry in SPSS and MS- Excel and data analysis.
Conducting research on the basis of project requirements.
Planned and implemented all activities with coordination staffs in the district.
Conducting regular monitoring of the project activities at the local level.
Planning and implementation of the project activities.
Worked on the weekly and monthly reports and reports to the Program Officer.
Assisted the program team to organize program related events and prepare event reports in
the district.
Worked on administration and documentation.
Supported in tentative budgeting in the district.
Coordinated with DHO and Health worker as per requirement of the activities.
Preparing and submitting success stories of the program activities.
Working close with district health worker and co-ordinate with them for Psychosocial
Counselling treatment data.

Previous employment

Please continue on a separate document if necessary and at least fill out five

previous employments.

Handicap International Nepal

Location
Employers name
From

May/2015

To

July/2015

Your job title

Maharajgunj, Kathmandu,
Nepal

Social Worker

2012

FAMILY PLANNING ASSOCIATION OF NEPAL

Employee Application Form

Brief Description of Responsibilities & Achievements/Assignment Undertaken:

Contributed to the assessment of beneficiaries needs as per scope of HI intervention

defined.
Facilitated rehabilitation care provision to the identified beneficiaries.
Worked as outreach team to identify, registers and analyses vulnerable beneficiaries.
Developed and follow up the network of focal point within the area of intervention and get
information about the general situation of most vulnerable beneficiaries and their access to
services.
Participated in community mobilization, facilitation and coordination with local
stakeholders.
Ensure the diffusion of information regarding other HI services as well as other actors
services.
Participated to the psychosocial strategy of intervention.

Nature of Employers
business

Employers name
From

Feb/2015

INGO

Reasons for
leaving

Foundation for Development Management

To

April/2015

Personal Problem

Location

Your job title

Sundhara, Kathmandu,
Nepal

Researcher

Brief Description of Responsibilities & Achievements/Assignment Undertaken:

Translated Nepali to Awadhi language and vice-versa in Reality Check Approach Research.
Conducted research in Kapilvastu district for Reality Check Approach component of the
DIFD supported integrated program for strengthening security and justice.
Conducted research for Helvetas Swiss Interoperations Trail Bridge Support Units Midterm review of Swiss Country Strategy 2013-2017 using the Reality Check Approach.

Nature of Employers
business

Employers name
From

April/2013

Research Consultancy

Reasons for
leaving

Nepal Disabled Association (Khagendra

New Life Home)
To

March/2014

Your job title

Research Accomplished

Location

Jorpati, Kathmandu,
Nepal

Social Mobiliser

Brief Description of Responsibilities & Achievements/Assignment Undertaken:

Motivated the persons with disabilities.

Provided psychosocial counselling to the persons severs with the disabilities.
Helped the disabled in physiotherapy.
Organized meetings and fundraiser programs.
Monitored the action and submit report to concerned team.
Keep record filing and of all the filled-out profiling questionnaires and other documents in
an organize manner.
Conducted meeting with parents and residents and reporting to the concerned authorities.
Assisted foreign volunteers for medical check-ups and physiotherapy.
Attend the meeting organized by the organization.
Maintaining confidentiality in organizational matter is the most.
Cooperating all the staffs and persons with disabilities in order to achieve the organizational
goal.

Nature of Employers
business

NGO

Reasons for
leaving

For Further Studies

(use additional sheets if required)

OTHER INFORMATION
Periods unaccounted for in employment history (e.g. career breaks, unemployment etc.)
Year ( From to)
Organization
Designation: Nature of assignments undertaken
2008-2009
Nepal Anti-Tuberculosis Social Mobiliser
Association
05/2013-11/2013
Kathmandu Training
Intern
Centre
2013-2015
Leo Club of Fulbari
Volunteer/Member
6 months
Divine Services Home
Intern
(use additional sheets if required)

Any Other Information that the Applicant May like to Add

Assisted to conduct, A study on Nutrition Food for Children In SOS Children Village, Sanothimi,
Bhaktapur
A study on Retroactive and Proactive Inhibition
A study on Cause of School Dropout in School Children
A study on Socioeconomic Status of drugs abuser at Richmond Fellow ship Nepal.
A study on what motivates employees at banks.
A study on Level of Abnormality in Different Psychological Aspect
A study on Relation Between Ethnicity and Self Esteem

STATEMENT OF SUITABILITY
2012

FAMILY PLANNING ASSOCIATION OF NEPAL

Employee Application Form

Reasons for Application

Please demonstrate how you meet the requirements of the person specification by providing details of
your experience, skills and knowledge gained in employment, voluntary work or other experience.
We will use the information you provide to decide whether or not to shortlist you for interview.
Please note - Your supporting statement must be no longer than two sides of A4 in Arial font, size 12.

I have completed Bachelors of Arts in Social Work (BSW) from Xavier International College,
where I have done more than 650 hours as an intern as well as conducted several social miniresearches in several humanitarian organizations.
I have worked with TPO Nepal as a senior monitoring and evaluation assistant where I have got
lots of opportunity to work for monitoring and evaluation related work. I also have an experience
as a research from Foundation for Development Management where I got an experience to
collect data through both qualitative and quantitative methods. During my working experience
with different organization, I have been adept in monitoring project activities, developing
/operating M&E tools/quality data and its management using statistical software (SPSS & MSexcel). Moreover, these experiences helped me to process, program evaluation and data
analysis. In recent position, I was fully responsible for creating database as well as managing all
project related information along with its good documentation and reporting. So, I think I am a
capable candidate for the post.

References
Please give the names of three people who are able to provide references relating to your work
experience and to your suitability for the post applied. One referee must be your current or most recent
employer.
SN

Name of Referee

Latest Position and Organization

Tel/Mobile and e-mail

2012

FAMILY PLANNING ASSOCIATION OF NEPAL

Employee Application Form

Mr. Damoder
Rimal

Ms. Neha Koirala

Mr.
Bahadur Giri

Project Manager (Transcultural

Psychosocial Organization Nepal)

rimaldamoder@gmail.com,
9851191011

Program Specialist ( Foundation for nehakoirala2@gmail.com,

Development Management)
9841351314
Raj Program Director, Kathmandu
9851086754
Training centre, Kathmandu, Nepal

Disclosure of Criminal Convictions

Have you any unspent convictions?
Yes

No

Please provide details.

(use additional sheets if required)

Signature
Please read the following points before signing below.

1. FPAN is a national service provider of sexual and reproductive health and rights for all. FPAN needs to
ensure that you are aware of:

(a)

FPAN has a goal of universal recognition of a womans right to choose and have access to safe
abortion.

(b)

Our work is guided by principles contained in the Code of Good Practice for Employee
Responding to HIV Workplace; Child Protection Policy and Sexual Harassment. If successful you
will be expected to work within these guidelines.
I confirm I have read and understood the above.

Yes

No

2. To comply with the requirements of the Migration Act, all candidates invited for interview will be
required to produce original document/s to prove their eligibility to work in Nepal.

3. By communicating the information on this form to FPAN by means of electronic communication, I

hereby indicate that I intend the information on this form to be taken as bearing my signed name
or signature as evidence of my intention to be bound by the form and evidence of my assertion
of the veracity of the information I have provided on this form.

4. I confirm that the information given on this form is, to the best of my knowledge, true and
complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.
Signature

Manis Verma

To return this form along with signed latest CV to

the office.

Date

12/11/2016

Or
email vacancy@fpan.org.np
Thank you for completing the application form.

2012