722 West 168th Street, 13th floor • New York, NY, 10032 USA

Tel: 212.342.0505 • Fax: 212.342.1824 • Website: icap.columbia.edu

BIOGRAPHICAL DATA SHEET

I. EMPLOYEE/CONTRACTOR (completion of all fields is required)
Potential Country of Assignment
Gender Last Name (Family Name) First (Given Name) M.I.
(only complete if working overseas)

Address

Telephone Number (include area code) Email Addresses

1) 2)

Place of Birth Citizenship (If non-U.S. citizen, give US visa status)

Position Being Considered for:

II. EDUCATION (include all college or university degrees)

NAME AND LOCATION OF INSTITUTION MAJOR DEGREE DATE

III. LANGUAGE PROFICIENCY

LANGUAGE Proficiency Proficiency

Speaking Reading

Biographical Data Form Revised March 2018, Page 1

 IV. EMPLOYMENT
Provide last three (3) years of employment history, listing salaries separately for each year. Continue on separate sheet of
paper if necessary to list all employment. Note: Salary definition – List base salary only. Exclude bonuses, profit-sharing
arrangements, commissions, consultant fees, extra or overtime work payment, overseas differential or quarters, cost of living
or dependent education allowances.
EMPLOYER NAME & DATES OF
ANNUAL
ADDRESS EMPLOYMENT
SALARY
POSITION TITLE PRIMARY RESPONSIBILITIES (mm/dd/yyyy)
Supervisor & Telephone US
FROM TO
Number DOLLARS

V. SPECIFIC CONSULTANT SERVICES, IF INDEPENDENT CONTRACTOR

[List assignments for last three (3) years]
DATES OF
CLIENT’S NAME & ADDRESS ASSIGNMENT DAILY RATE
(mm/dd/yyyy) # OF
SPECIFIC SERVICES PERFORMED
Point of Contact & Telephone DAYS
Number FROM TO US DOLLARS

Biographical Data Form Revised March 2018, Page 2

 VI. ADDITIONAL COMPENSATION
Please list any additional compensation, such as: housing, home leave, post differential, education for dependent
children, post allowance, repatriation assistance, utilities, etc., that you are currently receiving.

Type of Payment Amount per Month

CERTIFICATION: To the best of my knowledge, the above facts as stated above are true and correct.
Contractor certifies in submitting this form that they have taken reasonable steps (in accordance with sound business
practices) to verify the information contained in this form, understanding that ICAP may rely on the accuracy of such
information in negotiating and reimbursing personnel under this contract. The making of certifications that are false,
fictitious or fraudulent, or that are based on inadequately verified information may result in appropriate remedial action
ranging from refund claims to criminal prosecution.
Signature Date

INSTRUCTIONS FOR COMPLETING THE LANGUAGE PROFICIENCY PORTION

Indicate your language proficiency in block 13 using the following numeric interagency Language Roundtable levels
(Foreign Service Institute levels). Also, the following provides brief descriptions of proficiency levels 2,3,4 and 5. “S”
indicates speaking ability and “R” indicates reading ability. For more in-depth description of the levels refer to USAID
Handbook 28.

2. Limited working proficiency

S. Able to satisfy routine social demands and limited work requirements.
R. Sufficient comprehension to read simple, authentic written material in a form equivalent to usual
printing or typescript on familiar subjects.

3. General professional proficiency

S. Able to speak the language with sufficient structural accuracy and vocabulary to participate
effectively in most formal and informal conversations.
R. Able to read within a normal range of speed and with almost complete comprehension.

4. Advance professional proficiency

S. Able to use language fluently and accurately on all levels.
R. Nearly native ability to read and understand extremely difficult or abstract prose, colloquialisms and
slang.

5. Functional native proficiency

S. Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native
speaker.
R. Reading proficiency is functionally equivalent to that of the well-educated native reader.

UNI ASSIGNMENT through DIA upon hire - Country Office Human Resources ONLY
DATE (DIA Entry) UNI of NEW
ENTERED BY AFFILIATION(S) (administrative, academic or both)
(mm/dd/yyyy) HIRE

Please make sure this information is included in the payroll file.

Biographical Data Form Revised March 2018, Page 3