Last name

First name

Age

Nationality

Phone

E-mail

Place of residence or domicile

Current occupation

mother tongue according to your origin (specify)

What language(s) do you speak fluently? What language(s) do you speak fluently? French English Spanish German

Indicate other languages

Marital status Marital statusSingleConcubinagemarried monogamymarried polygamywidowerwidow

Number of children

Diplomas and training (indicate only university diplomas or technical studies)

Various professional experiences

Extra-professional activities

Skills (related or not to your training)

Have you ever done the orderly teaching of vocational training courses? Have you ever done the orderly teaching of vocational training courses? Yes no

If yes, give details

Are you or will you be obliged to perform national service? Are you or will you be obliged to perform national service? military civic any other

Other service, if existing

Have you traveled outside your country? Have you traveled outside your country? Yes no

If yes, indicate the country(ies), the reason(s) and the duration

Driver's license Driver's license car motorbike truck tractor any

Have you ever volunteered Have you ever volunteered Yes no

If yes, give the year, the place and your motivations

Medical Information (Indicate any serious physical, mental or chronic illnesses, disabilities or ailments from which you suffer or have suffered

Have you had to undergo treatment for a mental or emotional disorder? Have you had to undergo treatment for a mental or emotional disorder? Yes no

If yes give details

Have you taken out any outstanding loans? Have you taken out any outstanding loans? Yes no

If so, what kind? If so, what kind? student loan business loan (bank) borrowing from an individual

How did you hear about HAMA FOUNDATION? How did you hear about HAMA FOUNDATION? social networks website relatives word of mouth posters others

Other, please specify

What are your motivations for applying as: Member/volunteer/volunteer?

Indicate a duration for your membership

Can you work in difficult conditions? Which ones?

Give a brief description of your person (entertainment, values and hobbies)

Did you encounter any problems when filling out the form? Did you encounter any problems when filling out the form? Yes no

If yes, give details

Other information that you consider important

Signature (Name and surname), place and date

Affirmation of reading internal regulations, conditions of use and confidentiality Affirmation of reading internal regulations, conditions of use and confidentiality Approve conditions