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*Required
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GENERAL
QUESTIONNAIRE |
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Printable format |
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| PERSONAL
INFOMATION |
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| Surname
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| First
name |
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| *Sex |
Male |
Female |
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| Number
of dependants (If any) |
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| Date of
birth |
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(Year) |
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| *Place
of birth |
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*Citizenship
at birth
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*Present
citizenship
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*Country
of origin
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*Present
country of residence
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| Since(Date) |
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| Total years
abroad |
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| *How would
you like to be contacted? (Check the appropriate
boxes) |
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Address (Street, town, postal/zip code, country) |
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Telephone number |
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Mobile phone |
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Fax |
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E-mail |
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I prefer not to be
contacted at this time (Respondents who choose
this option are encouraged to contact IOM Addis
if this changes at any time) |
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| PROFESSIONAL
QUALIFICATIONS AND PRESENT OCCUPATION |
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| *Education
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Highest
qualification obtained |
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Field
of study
Hold down Ctrl Key for
multi-Selection
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Other,
please specify
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| Additional
fields of study |
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* Present
Occupation
(Choose one or more from the list)
Hold down Ctrl Key for
multi-Selection
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Other,
please specify
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| Years of
work experience |
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| Are you
interested to participate in this program? |
Yes
No |
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| *Do you
want to work in Africa? |
Yes |
No |
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| Do
you belong to any diaspora networks? |
Yes |
No |
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Please
specify
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| How did
you hear about us |
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Please
specify
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| *Disclaimer:
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| I declare
that the information provided can be shared with
MIDA partner organizations |
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without disclosure
of personal contact information such as Name,
Address and Phone number etc. |
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with personal contact
information |
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| Thank
you for taking the time to complete this questionnaire.
Please feel free to include any comments you have
that could improve this questionnaire and the
MIDA program more generally by going to our feedback
form. |
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