Annex 4

CENTRE OF EXCELLENCE FOR STABILITY POLICE UNITS

NOMINATION FORM –

TO BE FILLED IN ELECTRONICALLY BY THE NOMINEE

Family Name	Forename(s)
Date of Birth (mm-dd-yyyy)	mm	dd	yyyy	Rank
Sex	Nationality
Name and family name must be written as they are in the passport

Personal Details

Place of Birth	District of Birth
Father: Family name Forename(s)	Mother: Family name Forename(s)
Passport Number	Passport Type
National ID number
Home Address
Street
Postal Code + City
Country
Telephone
Work	Fax
Home
Mobile
E-Mail	@

Language Skills

Language	Scale 1- 4 (1 = Basic; 2 = Sufficient; 3 = Good; 4 = Excellent)
Listening	Reading	Writing	Speaking
ENGLISH
FRENCH
(NATIVE)

Future deployment

After the course at CoESPU I will be deployed
As trainer in national or regional peacekeeping training centers	Where?
In peacekeeping operations / missions	Where?
In the previous post

Professional Background

Recruitment date	(mm/dd/yyyy)
Promotion to current rank	(mm/dd/yyyy)

Current Position

Police Force / Army / Office complete denomination
Status
Post Title	From
Unit / Office	To	current
Duties	Unit Location
Work as a trainer?	If positive, please specify functions and teaching area

PROFESSIONAL DOMESTIC EXPERIENCE (Starting from the most recent one – cover at least the past 7 years)
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location

DUTIES RELATED TO PEACEKEEPING (Starting from the last one)
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location
Post Title	From
Unit / Office	To
Duties	Unit Location

Personal skills

Driving Skills	Driving License	Four Wheel Drive Experience
Computer Skills	Word Excel Access Powerpoint Other
Proficiency with firearms	Ability in use communication equipment

PROFESSIONAL BACKGROUND - Fields of Expertise
Training	Operations	Human Resources
Humanitarian Assistance	Investigations	Human Rights
Criminal Intelligence	Crowd Control	In Command
Logistics	Medical/Health	Prison Management / Security
Finance & Budgets	Information Technology	Staff
Communications	Planning	Border Service
Other Fields of Expertise

EDUCATION / COURSES RELATED TO PEACEKEEPING (Starting from the last one)
(Course Title)	From
(Training Organization & Country)	To
(Field of Study)
(Course Title)	From
(Training Organization & Country)	To
(Field of Study)
(Course Title)	From
(Training Organization & Country)	To
(Field of Study)

EDUCATIONAL BACKGROUND (highest qualification)
(Course Title)	From
(Institute & Country)	To
(Field of Study)

For the selection of the candidates for the Course CoESPU will take into account the following qualifications:

- good English/French skills (depending on the course language);

- involvement in training activities, as trainer or training manager;

- prevision of future deployment in Peacekeeping or Peace Support Operations;

- recent employment in Peacekeeping or Peace Support Operations.

Declaration of Nominee:

(A copy of this declaration, signed by the candidate, has to be kept by the sending Country)

By submitting this “Nomination Form” I confirm that all the information given is correct and complete. I also confirm that I agree to the following conditions of participation:

I am motivated

I accept that the intensive character of the programme does not allow for any additional commitments during the course.

I agree that an assessment of my performance during the course can be made.

I understand that COESPU reserves itself the right to communicate with the Sending State in order to deny admission in case of lack of requisites or that information given in the form proves to be incorrect and result in lack of requisites (i.e. insufficient language skills or lack of active service as a member of the Sending Country’s police force, etc.) or in case of dismissal from the course for any reason.

I authorize the Center of Excellence for Stability Police Units to collect and store my personal details for the purposes related with the course.

Submission of the nomination form:

The form has to be sent electronically via National Point of Contact (coespudsr@carabinieri.it) or via fax (0039 0444 932204) to the COESPU.

Health requirements:

Health requirements for the admission to the course are specified in a separate document.