Nominating Government:* | <Country
name> |
|
I. BRIEF PROFILE (150 words)* |
|
|
II. BASIC PERSONAL
INFORMATION* |
Please provide full names rather
than only acronyms or initials |
Title: | | Ms. | | Mr. | | Other: _________ | | Professor | | Dr. | | |
|
First and Last Name: | |
Employer / Organization: | |
Job Title: | |
Address: | |
Telephone: | |
Facsimile: | |
Email: | |
Web Site: | |
Year of Birth: | |
Gender: | |
Country of Birth: | |
Nationality: | |
Second Nationality: | |
|
III. DETAILS OF CURRENT
EMPLOYMENT* |
Name of Employer/Organization/Company:* | |
Department/Division/Unit:* | |
Start Date (YYYY):* | |
Type of Organization:* | | Academic or research institute | | Private sector (business and industry) | | Government agency | | Regional economic integration organization | | Inter-Governmental Organization (IGO) | | UN and other specialized agency of the UN Common System | | Non-Governmental Organization (NGO) | | Other:__________________ |
|
Main Areas of Responsibility:
(Briefly describe how your work relates to
biosafety and the area(s) of expertise for which you are being
nominated) | |
|
IV. EMPLOYMENT HISTORY* |
Countries or regions where you have worked: | |
Please give details of previous
employment beginning with the most recent previous employer. |
Previous professional experience
1 |
Name of Employer/Organization/Company:* | |
Department/Division/Unit:* | |
Start and End Date (YYYY - YYYY): | |
Type of Organization:* | | Academic or research institute | | Private sector (business and industry) | | Government agency | | Regional economic integration organization | | Inter-Governmental Organization (IGO) | | UN and other specialized agency of the UN Common System | | Non-Governmental Organization (NGO) | | Other:__________________ |
|
Main Areas of Responsibility and Accomplishments:
(Briefly describe how your work related to
biosafety and the area(s) of expertise for which you are being
nominated) | |
Previous professional experience
2 |
Name of Employer/Organization:* | |
Department/Division/Unit:* | |
Start and End Date (YYYY - YYYY): | |
Type of Organization:* | | Academic or research institute | | Private sector (business and industry) | | Government agency | | Regional economic integration organization | | Inter-Governmental Organization (IGO) | | UN and other specialized agency of the UN Common System | | Non-Governmental Organization (NGO) | | Other:__________________ |
|
Main Areas of Responsibility:
(Briefly describe how your work related to
biosafety and the area(s) of expertise for which you are) | |
Previous professional experience
3 |
Name of Employer/Organization/Company: | |
Department/Division/Unit:* | |
Start and End Date (YYYY - YYYY): | |
Type of Organization:* | | Academic or research institute | | Private sector (business and industry) | | Government agency | | Regional economic integration organization | | Inter-Governmental Organization (IGO) | | UN and other specialized agency of the UN Common System | | Non-Governmental Organization (NGO) | | Other:__________________ |
|
Main Areas of Responsibility:
(Briefly describe how your work related to
biosafety and the area(s) of expertise for which you are ) | |
|
V. EDUCATION |
A. Formal Education* |
First Degree (e.g. B.Sc. in
Microbiology)* |
Title of the first Degree or other academic
distinction and subject:* | <Text entry> |
Name of academic institution:* | <Text entry> |
Dates (from / to):* | From <YYYY> to <YYYY> |
Second Degree (e.g. M.Sc. in
Microbiology)* |
Title of the second degree or other academic
distinction and subject:* | <Text entry> |
Name of academic institution*: | <Text entry> |
Dates (from / to): | From <YYYY> to <YYYY> |
Third Degree (e.g. Ph.D. in
Microbiology) |
Title of the third Degree or other academic
distinction and subject: | <Text entry> |
Name of academic institution: | <Text entry> |
Dates (from / to): | From <YYYY> to <YYYY> |
B. Other professional
qualifications |
List a maximum of three other relevant professional
qualifications:
(e.g. specialized training, certifications
obtained, etc.) | - <Text entry>
- <Text entry>
- <Text entry>
|
|
VI. AREAS OF EXPERTISE* |
Please select one main area of expertise and
up to 3 specific fields in which your academic and professional
expertise may assist Parties in implementing the Cartagena Protocol
on Biosafety: Biosafety policy and legal
expertise
Biosafety law
Biosafety policy
Biotechnology policy
Compliance and Enforcement
Handling of LMO applications (AIA procedure)
Import / Export control
Liability and redress
Multilateral agreements
Capacity development expertise
Institutional capacity
development
Project design, monitoring and evaluation
Resource mobilization
Information and knowledge management expertise
Biosafety Clearing-House
Biosafety database management
Biosafety website development
IT network development
Public awareness, education and participation expertise
Access to information
Biosafety education
Media communication
Public awareness-raising
Public participation
Risk communication
Scientific and technical expertise
Food and feed safety
Human health
LMO monitoring
LMO sampling and detection
Risk assessment
Risk management
Socio-economic and trade expertise
Bioethics
Coexistence
Intellectual property rights
Social and/or economic assessments
Trade rules and standards
Other (please specify) <Text
entry> |
|
VII. PUBLICATIONS |
List your three most important publications related to your
main field of expertise: | - <Text entry>
- <Text entry>
- <Text entry>
|
List other publications
(Please list up to 20 most relevant citations
of peer-reviewed articles, books, book chapters, conference papers
and other publications; Attach a separate list of publications if
the space provided here is not sufficient): | - <Text entry>
- <Text entry>
- <Text entry>
- <Text entry>
- <Text entry>
and/or <Attachment> |
|
VIII. AWARDS AND PROFESSIONAL
MEMBERSHIPS |
Awards received List up to three scientific / professional
awards received that are related to your main field of
expertise: | - <Text entry>
- <Text entry>
- <Text entry>
|
Professional memberships List up to three relevant professional
societies or organizations of which you are a member: | - <Text entry>
- <Text entry>
- <Text entry>
|
Technical committees, expert panels or advisory bodies
served List up to three relevant technical
committees, expert panels or advisory bodies on which you have
served and briefly describe your specific responsibilities: | - <Text entry>
- <Text entry>
- <Text entry>
|
|
IX. LANGUAGE PROFICIENCY* |
Mother tongue:* | | Arabic | | English | | Russian | | Chinese | | French | | Spanish | Other (specify): | <Text entry> |
|
Other languages |
Speaking:* | Arabic | | Excellent | | Good | | Fair | Chinese | | Excellent | | Good | | Fair | English | | Excellent | | Good | | Fair | French | | Excellent | | Good | | Fair | Russian | | Excellent | | Good | | Fair | Spanish | | Excellent | | Good | | Fair | Other (specify): | <Text entry> | | | Excellent | | Good | | Fair |
|
Reading:* | Arabic | | Excellent | | Good | | Fair | Chinese | | Excellent | | Good | | Fair | English | | Excellent | | Good | | Fair | French | | Excellent | | Good | | Fair | Russian | | Excellent | | Good | | Fair | Spanish | | Excellent | | Good | | Fair | Other (specify): | <Text entry> | | | Excellent | | Good | | Fair |
|
Writing:* | Arabic | | Excellent | | Good | | Fair | Chinese | | Excellent | | Good | | Fair | English | | Excellent | | Good | | Fair | French | | Excellent | | Good | | Fair | Russian | | Excellent | | Good | | Fair | Spanish | | Excellent | | Good | | Fair | Other (specify): | <Text entry> | | | Excellent | | Good | | Fair |
|
|
X. PROFESSIONAL REFERENCES |
Please indicate at least one but not more than
three references with detailed contact information:*
For each reference please attach a "Contact
details" common format(s)* | Reference 1:* | <Text entry> | Reference 2: | <Text entry> | Reference 3: | <Text entry> |
|
|
XI. ANY OTHER RELEVANT
INFORMATION |
Please provide any other information relevant
to your role as an expert (max. 300 words) <Text entry> |
|
RECORD VALIDATION |
Date*: | <YYYY-MM-DD> |
Country*: | <Country name> |
Name of the Cartagena protocol National Focal Point:* | <Text entry> |
I hereby confirm the nomination of
the above named person to the Roster of Expert and that the
information contained in this form is correct. Signature of the
Cartagena Protocol National Focal Point:* |
Name of the BCH National Focal Point:* | <Text entry> |
I hereby agree to the inclusion of
the above information in the Biosafety Clearing-House. |
Signature of the BCH National Focal Point:* | |