Form Aid 1420-17 - Contractor Employee Biographical Data Sheet (Page 2 of 3) in pdf

INSTRUCTIONS

The biodata form, which is required for all USAID proposals, details a person’s salary history by year and justifies the proposed daily rate on a project. All

responses need to be legibly hand-written in ink and/or typed.

Please fill in the following boxes.

1. Name – Provide in the following order your last, first and middle name.

3. Address – Provide home mailing address, including zip code.

Blocks 2, 4, 5, 6, and 7 are filled out by Social Impact, and not by the contractor employee.

8. Telephone Number – Provide the best telephone number to contact you on, including area code.

9. Place of Birth – List place of birth: city, state and country.

10. Citizenship – Indicate citizenship.

11. Dependents – List the full names, ages and relationships of dependents to accompany you to the country of assignment. If there are no dependents

indicate a N/A, for not applicable.

12. Education – List the name and location of the institution, your major and degree. Provide the month and year the degree was received. (Include only

college or university degrees, not high school diplomas or certificates.) See example below.

NAME AND LOCATION OF INSTITUTION

MAJOR

DEGREE

DATE

Georgetown University, Washington DC

Demography

8/99

13. Language Proficiency – Indicate your language proficiency in block 13 using the following numeric Interagency Language Roundtable levels (Foreign

Service Institute Levels). Also, the following provides brief descriptions of proficiency levels 2, 3, 4, and 5. “S” indicates speaking ability and “R” indicates

reading ability. For more in-depth description of the levels refer to USAID Handbook 28 or superseding policy directive.

2. Limited working proficiency

Able to satisfy routine special demands and limited work requirements.

Sufficient comprehension to read simple, authentic written material in a form equivalent to usual printing or typescript on familiar subjects

within familiar contexts.

3. General professional proficiency

Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively

in most formal and informal

conversations on practical, social, and professional topics.

Able to read within a normal range of speed and with almost complete comprehension of a variety of authentic prose material on

unfamiliar subjects.

4. Advanced professional proficiency

Able to use the language fluently and accurately on all levels normally pertinent to professional needs.

Able to read fluently and accurately all styles and forms of the language pertinent to professional needs.

Functional native proficiency

Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker

and reflects the cultural standards

of a country where the language is natively spoken

Reading proficiency is functionally equivalent to that of the well-educated native reader.

14. Employment History – (Note for Professional Service Contractors only, please go directly to section 15 to record your employment history.)

For the last (3) years, indicate position title, employers name and address. Information should be as complete and recent as possible. Include a point of

contact at the employer and telephone number. Provide the dates of employment, month and year. In U.S. dollars, list annual salaries separate for each

year. (Continue on separate sheet of paper if required to list all employment related to duties of proposed assignment.) See example below.



Salary definition - basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions, and consultant

fees, extra or overtime work payments, overseas differential, or quarters, cost of living or dependent education allowances.

EMPLOYER’S NAME AND ADDRESS

Dates of employment (M/D/Y)

Annual Salary

POINT OF CONTACT AND TELEPHONE #

POSITION TITLE

From

Dollars

15. Consultant Services – For the last (3) years indicate services performed, employers name and address. Information should be as complete and

recent as possible. Include a point of contact at the employer and telephone number. Provide the dates of employment, month and year, in addition to the

number of days worked. In U.S. dollars, list daily rates for each specific consultancy.

16. Signature of Employee – Provide signature and indicate the date the document was signed. The biodata sheet is not valid unless it has been

signed by the contractor employee.

17. Signature of Contractor’s Representative – This block is designated only for the signature of a Social Impact representative.

AID 1420-17 (04/2007)

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