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2010 Population and Housing Census

FIELD STAFF RECRUITMENT FORM

General Personal Details

Surname Your surname is required.Surname must not exceed 19 characters.	First Name Your first name is required.First name must not exceed 19 characters.	Middle Name	Maiden Name

Sex:
Male Female
Please choose your gender.

Date of birth (dd/mm/yyyy)

Your date of birth is required.
Invalid date format.Your date of birth must not be before 01/01/1945.Your date of birth must not be after 31/12/1996.

Place of birth

Your place of birth is required.

Nationality Ghanaian Non-Ghanaian Nationality is required.	Current Residence
	Region
	District
	Town/Village	Your town / village of residence is required.

Contact Address, Telephone and Email
Postal address	Your postal address is required.
Telephone (fixed line)
Email address
Mobile phone (i)	Enter Cell phone number.Invalid format.Characters are too many.Number is not correct.	Mobile phone (ii)
Have you ever been arrested, indicted, or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned for the violation of any law (excluding minor traffic violations)? Yes No
If yes, give explanation of each case:

Highest Education
Name of Institution	City / Town	Country	Date Attended From (mm/yyyy)
Name of your highest educational level institution is required.Exceeded maximum number of characters.	Name of city is required.	Enter name of country.	Your start date is required.Please enter start month and year.Please enter start month and year.
Qualification	Other Qualification	Main Course of Study or Area of Specialization	Date Attended To (mm/yyyy)
Select your qualification from the list provided.Please choose from the list of qualifications provided.		Your main course of study or Area of specialization is required.	Your end date is required.Please enter end month and year.Please enter end month and year.
Please note that if you are invited, you will be required to show your original certificate(s) and submit two (2) recent passport photographs at the time of interview.

Employment (Not for GES teachers)
Are you currently employed or have you ever been employed? Yes currently employed Yes previously employed No
If yes, state your present post/last employment:
Job Title	Worked From	Worked To
	(dd/mm/yyyy)	(dd/mm/yyyy)

Name of Institution	Sector of Employment
	Public Private NGO International
Institution's contact number	Name of Supervisor	Supervisor's Contact Number	Supervisor's Email

Address of Current Employer/Last Employer
Description of Duties:
Summarize any of your achievements
Have you any objections to our making inquiries of your present employer? Yes No
If yes, explain:

Indicate any relevant experience in field work. (TO BE ANSWERED BY ALL APPLICANTS)
In which of the following censuses were you involved (indicate the most recent one)? 1970 1984 2000
Period of engagement in above census	Start date (dd/mm/yyyy)		End date (dd/mm/yyyy)
Indicate position in Census
Indicate any survey / data collection you have been involved in.
Indicate position in Fieldwork
Period of engagement in above Fieldwork	Start date (dd/mm/yyyy)	End date (dd/mm/yyyy)
Name of contact person in Fieldwork:		Contact person Phone number
Institution/Organization/Researcher:

For GES Teachers Only
If you are a GES TEACHER, what is the name of your school?
Name of Circuit	Name of Circuit Supervisor	Name of Head teacher
Are you a primary/JHS/SHS teacher Primary JHS SHS	Town/Villlage where school is located

Relations (TO BE ANSWERED BY ALL APPLICANTS)
Is any of your relatives employed by the Ghana Statistical Service or by the District Assembly where you are resident? Yes No
If yes, list any relatives employed by the Ghana Statistical Service(GSS)/District Assembly (DA) below:
Name of Relative	Position in GSS/DA	Town	Relationship

Language Proficiency

Use the following ratings to indicate your proficiency in Languages. (1) With difficulty (2) Fair (3)Good (4) Very Good
List any of the Ghanaian language spoken or written and indicate your proficiency using the above ratings.
Ghanaian Language	Read	Write	Speak	Understand
1. At least one Ghanaina Lang. is required.
2.

In addition to the Ghanaian languages, list any foreign languages you can speak. (1) With difficulty (2) Fair (3)Good (4) Very Good
Language	Read	Write	Speak	Understand
1. English
2.

Identification

Passport	Number	Voter ID Card	Number
	Expiry Date (dd/mm/yyyy)
National ID	Number	NHIS Card	Number
	Expiry Date (dd/mm/yyyy)		Expiry Date (dd/mm/yyyy)
Employment ID	Number	Student ID Card	Number
	Expiry Date (dd/mm/yyyy)		Expiry Date (dd/mm/yyyy)
GNAT / NAGRAT	Number	Driving License	Number
	Expiry Date (dd/mm/yyyy)		Expiry Date (dd/mm/yyyy)

Means of transport
Do you have any of the following?
Bicycle	Motorcycle	Saloon Car	Pick-up/4x4
Other, specify
Alternative Districts of work
You will be required to work in your district of current residence if selected. However, list two other District(s) in order of preference if you are required to work in another district.
Region:		Region:
a. Alternative District		b. Alternative District

Referees
Give at least one referee, who is not your relative, and not a GSS staff, but is familiar with your character and qualifications.
Name of referee	Relation with referee	Referee's mobile phone number	Email address of referee
A referee is required.	Provide relation with referee.	Referee's no. is required.Invalid format.Phone number is not correct.Exceeded required number of characters.

Declaration: I undertake that the information provided is true. I understand that false statements will result in disqualification and may be liable for prosecution. Please note that the statements submitted will be verified.

Disclaimer: Ghana Statistical Service accepts no responsibility legal or otherwise in the event that this record is intercepted or corrupted in any form by a third party.Please report any anomaly to us and we will deal with it urgently.
I have read, understood and I agree with the declaration and disclaimer.
Please check the declaration box.