You must answer these questions fully and honestly.

Extensive checks will be made to verify the information provided by shortlisted applicants.

Any applicant who has been found to have answered questions dishonestly, in an attempt to mislead the selection panel, will not only be rejected by this scheme but may be blacklisted which would affect applications to any US Embassy Mogadishu opportunities (recruitments, solicitation s etc) in future.

You can either complete this form online – in which case you can save it and return to it later.  We would prefer you do this.  But if your internet does not allow that, you can download it and email it to us at somalia[at]minorityrights.org.

You will need to attach several documents as proof of your answers, please allow yourself time to collect and attach these. If you have any difficulty completing the form or you do not have the required documents available to you, please email somalia[at]minorityrights.org.

All completed forms with necessary attachments must be submitted by xx.xx.2021.

    Section A – About you




    MFPrefer not to say






    Section B – Links to South West State


    YesNo


    More than 5 yearsLess than 5 years


    Section C – belonging to a minority or marginalised community


    YesNo


    Section D – qualification or qualified by experience


    YesNo


    University:

    Dates of study:

    Qualification awarded:

    Grade awarded:

    Subject:


    YesNo

    University:

    Dates of study:

    Level and grade awarded:

    Subject:

    If you have not studied at university level or have done so for less than 2 years, you may still be eligible for this scheme, but you will need to have 4 or more years work experience at a professional level.


    Section E – community activism


    Section F – public service


    Please provide the names, positions and contact details of two referees who know you well. At least one of these references should be a respected member of a marginalised or minority community who can confirm your membership of their community and either:

    • Is recognised as a leader of that community OR
    • Has an official position e.g. Federal MP or SWS MP as a representative of that community OR
    • Has a strong and visible track record of activism on behalf of that community (e.g. as the Executive Director of a minority led NGO, or as a well known journalist from that community).

    The second reference should be able to confirm your activism on behalf of a community or your commitment to public service.

    Reference 1

    Name:

    Community:

    Position in community:

    Telephone number:

    Reference 2

    Name:

    Knowledge of your public service or community activism:

    Position:

    Telephone number:

    Both references must have agreed to be contacted by our team for verification purposes. If we are unable to contact referees, your application may well be rejected.

    Attachments

    Proof of date of birth (for example: birth certificate, passport, ID card, dated record of primary schooling):

    Proof of residence in SWS (for example, ID, passport, bill citing address, bank statement, letter from employer citing address, date stamped photo with known landmark or building: town/city: ----------------------; Region: --------------------) OR proof of links to SWS (for example birth certification, record of schooling or work in SWS):

    Proof of university degree OR proof of two years university study OR proof of professional experience similar to that of a university graduate in a relevant field:

    CV:

    You may also submit any other evidence that you have available of your public service, your community activism or any other document that you feel will support our evaluation of your application:


    I am unable to supply the following:

    For these reasons:


    If you have not selected the box above, your choices won't be considered.
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