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MICT INTERNSHIP PROGRAMME

PART I: APPLICATION FORM


(TO BE COMPLETED BY APPLICANT)
United Nations
Nations Unies
Note: This application form consists of four (4) pages are to be completed by the applicant. Incomplete forms will not
be considered nor returned.
Mechanism for
International PART I - TO BE COMPLETED BY THE APPLICANT
Criminal Tribunals

Mécanisme pour les Please indicate which Branch you are applying for with this application by checking one of the boxes below. If you
Tribunaux Pénaux wish you apply to both Branches, you must submit a separate application for each.
Internationaux
ARUSHA BRANCH (TANZANIA)
OR
THE HAGUE BRANCH (NETHERLANDS)

Please indicate which Organ(s) you are applying for by checking the box(es) below.

OFFICE OF THE PRESIDENT


CHAMBERS
OFFICE OF THE PROSECUTOR
REGISTRY

Dates proposed for Internship:

From:       To:      

Please check if you are also available for other start dates outside of the proposed dates.

List alternate date(s) :      

1. FAMILY NAME FIRST NAME 2. SEX 3. MARITAL STATUS

                       

4. DATE OF BIRTH (DD/MM/YY) 5. PLACE OF BIRTH 6. PRESENT NATIONALITY


                 

7. PERMANENT HOME ADDRESS 8. PRESENT ADDRESS

          

Telephone No.       Telephone No.      

9. E-MAIL ADDRESS:

     

10. IN CASE OF EMERGENCY NOTIFY: Name:      

Address:      

Telephone No.      

Arusha International Conference Centre, P.O. Box 6016, Arusha, Tanzania


Churchillplein 1, 2517 JW The Hague. P.O. Box 13888, 2501 EW The Hague, Netherlands
11. INSURANCE: I HEREBY CONFIRM THAT I HOLD A HEALTH/ACCIDENT INSURANCE POLICY WITH

Name of Insurer:      

Yes, I hold a health/accident insurance policy No, I do not hold a health/accident insurance policy

This policy is due to expire on      

***Please attach a copy of the policy or policyholder’s card.

12. KNOWLEDGE OF LANGUAGES :


Read Write Speak Understand
Easily/Not Easily Easily/Not Easily Easily/Not Easily Easily/Not Easily
English
French
Other:___________
Other:___________

13. HIGHER EDUCATION (COLLEGE AND/OR UNIVERSITY OR EQUIVALENT):

Institution Years Attended Degrees Obtained Major Subjects of Study


(Name, Place and Country) (From/ To)

                       

Degrees Expected

                       

14. RELEVANT EXTRA CURRICULAR OR VOLUNTEER ACTIVITIES DURING STUDIES:

     

15. Have you done any Military Service? Yes No


If you have answered "Yes" to this question, please provide full particulars of Months :      
time period. Years :      

16. PUBLISHED BOOKS OR ARTICLES:

     
17. ACADEMIC REQUIREMENTS FOR INTERNSHIP (if applicable).

If required to draft and submit academic papers, research or similar, please indicate the specific requirements from
your academic institution. If available, submit academic institution requirement sheet.

     

18. AWARDS/ HONOURS/ SCHOLARSHIPS RECEIVED:

     

19. EMPLOYMENT:
Please describe any previous practical experience you may have had, giving full details of your duties. Use additional
pages, if necessary. Alternatively, you may attach a resumé or curriculum vitae (CV).

     

20. CAREER PLANS:

     
21. REFERENCES: Please provide details of two persons not related to you, who are familiar with your character
and qualifications. Please refer to the Reference Form (Part III), and be sure to include their letters of
recommendation with your application.

FULL NAME FULL ADDRESS BUSINESS OR OCCUPATION


                 
                 
                 
22. Have you any objections to us making an inquiry at your present
Yes No
employer/supervisor?

23. As far as you are aware, have you any personal or professional
connection to or affiliation with:
(a) any of the parties to the conflict in the territory of the former Socialist
Yes No
Federal Republic of Yugoslavia; and/or
(b) any of the parties to the conflict in Rwanda; and/or Yes No
(c) any party to a case which is currently pending before the ICTY or ICTR
Yes No
or MICT; and/or
(d) any person otherwise working for the ICTY or ICTR or MICT. Yes No

If you have answered "Yes" to any part of this question, please provide full particulars in an attached statement.

24. To this application I have attached a copy / original of the following documents:
(a) Cover letter (letter of intent) Yes No
(b) Two (2) written References/ Recommendations on letterhead as detailed
Yes No
in Part II
(c) Writing sample (legal internships only; no more than 10 pages) Yes No / Non Legal
(d) University/law studies transcripts, including courses taken and grades
Yes No
received (unofficial transcripts acceptable)

***IMPORTANT NOTE***: If you have answered “No” to any part of this


question, please be informed that your application will be deemed
incomplete and may not be reviewed for selection. Applications will not
be accepted when sent in parts.

25. Application Checklist


(a) I have answered all the questions Yes No
(b) I have attached copies of all necessary documents Yes No
(c) I am in my final stages of a relevant degree or have already completed a
Yes No
relevant degree
(d) I am available to complete an internship of at least 3 months on a full
Yes No
time basis

***IMPORTANT NOTE***: To be eligible, you must answer "Yes" to all questions above. If you have answered
"No" to any part of this question, you should consider postponing your application until the above requirements are
met.

26. I certify that the statements made by me in answer to the foregoing questions are true and complete to the best of
my knowledge and belief.

___________________________ ___________________
(Signature) (Date)
MICT INTERNSHIP PROGRAMME

PART II : REFERENCE FORM


(TO BE ATTACHED TO LETTER OF REFERENCE/RECOMMENDATION)

References listed by the Applicant at Question 21 of Part I of the MICT Application are asked to
attach a recently dated, signed and sealed recommendation to this form.

The purpose of this form is to provide the internship coordinators with additional information
relating to the Applicant. Recommendations which are of most value, therefore, are those which
provide relevant information not found elsewhere in the Applicant’s submission. References are
asked to address the following issues:

1. The capacity in which you know or have known the Applicant.

2. Whether the Applicant has special interests, motivations, personal qualities, or a


background which may distinguish him or her from other Applicants.

3. How the Applicant compares with contemporaries.

4. The Applicant’s capacity to engage in a sustained and intensive research projects.

5. The Applicant’s interpersonal skills and level of maturity.

Please do not send the references separately or directly to the MICT. The Applicant is required to
submit this reference together with his or her internship Application.

The MICT thanks you for your assistance.