Assessors Registration Form Personal Information English Assessor Name

Assessors Registration Form Personal Information English Assessor Name Organization Name □ Government □ Private □ SME □ Association or Society □ Others Designation Nationality ID Number Email Contact Organization Type Arabic ﺣﻜﻮﻣﻴﺔ □ ﺧﺎﺻﺔ □ ﻣﺆﺴﺴﺔ ﺻﻐﻴﺮﺓ ﻭﻣﺘﻮﺳﻄﺔ □ ﺟﻤﻌﻴﺔ ﺃﻮ ﻣﺆﺴﺴﺔ ﻣﺪﻧﻴﺔ □ ﺃﺨﺮﻯ □ Area of Expertise : (max 50 words) Arabic Language Fluency Speaking Basic Good Excellent Writing Basic Good Excellent List most recent positions held (maximum 3) Organization From Designation List main academic qualifications (maximum 3) Organization Qualification 1 To Business Activity Year 1 - 2 -

List latest 3 relevant professional qualifications Organization Qualification Year 1 - 2 - 3 List prior experience in Award Jury or Assessment (maximum 3) Award name Award Organization Year 1 - 2 - Role (Jury/Lead Assessor/ Assessor) 3 List relevant memberships (maximum 3) Membership Title Awarding Body 1 - 2 - Year 3 Availability Please accept to be available on following dates Awarding Body Website URL □ b) Assessment dates –from 29 September -26 November 2019 □ a) Assessors Training workshop (24 -26 September 2019) Approximate duration of the assignment availability (yes/No) 10 -15 days 16 -25 days 26 -30 days □ I confirm all information provided is an accurate record of my professional history to date 2