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Sudurpashchim Province

Provincial Center for Good Governance (PCGG)Punna- Doti

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APPLICATIONFORMFORTHEROSTER0FEXPERTS/RESOURCEPERSON

Background

ProvincialCenterforGoodGovernancehasbeenestablishedunderOfficeofChiefMinisterandCouncH of Minister as an autonomous knowledge center that aims at' enhancing thecompetencyofelected,nominatedandappointedofficialsandthepersonnelworkingprimarilyin Provincial and the Local Governments; and supporting Provincial and Local governments in

implementing developmental and governance reform programs by creating new knowledgeand contributing to existing knowledge-base through research, studies and practicalexperiences. The center aims to be a Center a/ Exce//ence for competent ProvincialGovernment and weH versed Local Levels; and conducts quality training, on-site coaching,mentoring and action research.The center m6bilizes competent professionals to achieve its objectives; and invites applicationfor the roster from qualified experts (ind.ividuals). The individuals who meet the qualifications

and,experiencesandareinterestedtoworkwithcenterarerequestedtofiHuptheformbelowand`-submit to center through the email: [email protected], Incomplete forms win not beaccepted.

(1) Personal Information:

Family name:

Nationality:

First name(s):

Date of birth (year):

Middle Name:

P.resent Status: Freelancer

If employed, employed by:

Department:

position/title:

9g±tactinformatjQj]

QffiseResidence

Street/Ward:

E-mail:

PAN no:

(Z) Academic Qualification

Degree Subject University/School Year ofCompletion Specialization

+I

E=(3) Field of Expertise

areasofexpertisethati]estfittoyourexperienceandexpertise(selectmaximum10areas).

Area.s of ExpehisePlease tick El

•NO,

Governance, Local.Governance and FederalismFiduciaryRiskReductionActionPlan(FRRAP)in LGsProjectCycleManagement(PCM)Locallevelplanningandmonitoring ,Mid-termExpenditureFramework(MTEF}LocalizationofSustainableDevelopmentGoals(SDGs)PublicFinancialManagement(PFM)andpublicprocurement |I

•1

I2 I34

I5 I6

7I

a9 ln-Service training to Province and LG's staffServiceEntryTrainingtoProvinceandLG'sstaffGenderEqualityandSocialInclusion(GESI)WorkplaceHarassmenttrainingandcodeofconduct preparation

10

11

12 Disaster Risk Management (DRM)

13|EnvironmentFriendlyLocalGovernance(EFLG)|LocalGovernmentplnstitutionalcapacityAssessment(LISA)

'

14

15 Information Communication TechnologyCapacityDevelopmentofJudicialcommittees of LGs

Iii=

Select the

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17 Mediation training (TOT) to Local level mediators

18 Public Services Delivery of LGs

ae Social Accountability (SA) /SA Tools i.e Public Audit, Public hearing

20 Leadership developmentITeam building /InterpersonalCommunication Skills

212223.24 Appreciative Inquiry

Proposal and Report Writing

Hospitality management & courtesy

others(Please'.Specify............„.................)

I

(4) Experience

Please state briefly your experience in relation to the section (3) above.

P sition Start Date End Date Major RolesS. NO, Organization a I'IIILLL-

+

a,`

(5) Skills

Pleasecompletetheappropriatesectionsbelowinaccordancewithyourmasteryofskilland

proficiency.

a Training Design and curriculum DevelopmentProfessional Moderate Basic

' None

b Training workshop Faci itationProfessional Moderate Basic None

q= P t-Trainin Su ort On-Sitecoac ing Follow-Upt. OS 8 PProfessionalP,,ModerateBasic None

Research an Ana ysisProfessional Moderate Basic None

e planning and strategy Formu ation

Professional Moderate Basic None

Provi in onsutancy ervices.. t Professional Moderate Basic None

EI

-

(6)BE¥:=:::I:::::#=:==£:::flments(AssimmentName±f

S.N. Training/Assignment Number of Level of Organization

Name Event/LGS Participants

1`

2345678 \

.iS

(7) List of Relevant Publications (Title. Year of Publication. Publisher

S.N. Title Year of Publication Publisher

I-

(8) ngrticil.ation in Traininq Courses (Major and Strtegic Only/relevaE±±±g|

4

t

(9) Language Proficiencv

Tick (V) each language that you know and put appropriate numbers for Read, Write, Speak andUnderstand accordiing to vour prof.iciieney..1 - Fluently; 2 - Well; 3 - With difficulty; 4 - Npt at all

Language Read write Speak Understand

I Nepa,i

I EnglishIIH +

±Q: Other Rele`/ant Information (if anvl

11. Declaration

I agree to the consent to collection, usage and disclosure of personal information for the purposementioned above.

Signature

a

Please submit at: [email protected]

Contact No: 094-411172/9865642591/9858440084

Date

L

'E EifiERE fa

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