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Health Cluster Haiti
Volunteer Registry Application Form Print E-mail
/** modified agosto 1 2012 para que se pueda meter con los otros sitemas de hojas de vida */

Thank you for your concern for the people of Haiti and for your willingness to assist. The Pan American Health Organization and the World Health Organization have rosters of trained, assessed and qualified individuals within and outside the Organizations who are available for rapid deployment to emergency situations. In addition, PAHO/WHO is compiling an electronic roster of individuals who meet basic criteria.


When you register your name in this roster, you will be asked to provide PAHO with certain information including, but not necessarily limited to, valid contact information (e.g., telephone number, email address, etc.), skills, and employment information. You understand and agree that PAHO may disclose and share your information in whole or part to any and all entities participating in the Health Cluster in Haiti. You also understand that this roster database is intended to provide PAHO and the Health Cluster in Haiti with a list of potential volunteers to assist in the current efforts in Haiti, and there is no guarantee that your skills will be required by PAHO or any partner in the Health Cluster in Haiti.

Please fill the form below and attach your resumé (CV):

*First Name  

*Last Name  

Core Data




Cell phone  




Postal Code  


Date of Birth  *Day    *Month    *Year   


Other nationalities, if applicable   


*Languages (please select your level in each one):

French Creole
English Spanish

*Years of experience   

*Specialty: medical, public health, disasters   

Administrator Architect
Attorney Civil Engineer
Informatics Medical Doctor
Medicine Nurse
Other Pharmacist
Public Health Sanitary Engineer
Scientist Telecommunications

*Technical Skills   

Administrator Coordination
Disaster Mitigation Environmental health
Epidemiologist Information/Communication
Logistics Logistics (Response)
Logistic Support System Instructor Logistic Support System Operator
Management Medical Coordination in Disasters
Medicines management and/or selection Mental Health
Mitigation/Safe Hospitals Multisectorial Disaster Coordination
Public Health Disaster Coordination Training

*Type of Experience   

Academic (Universities & Scientists) Bilateral Donors
Civil Defense Health Ministry
Health Other Health Social Security
Military Mass Media
Multilateral / Regional Non-Governmental Organization
Other Red Cross
other UN agencies (no WHO/PAHO) WHO or PAHO


Conditions of service in Haiti are currently classified as harsh to extremely harsh. As such, volunteers need to understand that they will be required to be self-sufficient in terms of travel, lodging and food, at least in the early stages following deployment.

*Do you consider yourself to be self-sufficient (food, water, lodging and travel): 

*Dates of availability

From:   *Day    *Month    *Year   

To:   *Day    *Month    *Year   

*What type of assignment are you interested in?   Volunteer Contract Either


*As a security phase is in effect in Haiti, a travel security clearance is necessary for all UN travel to Haiti. Such clearance is not required for non-UN personnel travel (e.g. non-UN Health Cluster personnel).

With the purpose of minimizing risks and providing greater protection to all staff, in particular staff members operating in hazardous situations, the United Nations has established a self-administered learning program covering all aspects of security.

The learning programs (basic and advanced) provide training on various aspects of personal safety, health and welfare. They are designed to raise staff members' level of awareness of possible threats, whether in the field or at home. It also provides practical guidance to staff members on what can be done to prevent, avoid or reduce risks, and how to react in the event of actual danger, threat or injury.

Have you taken the Basic and Advanced UN security in the Field training programs? [Basic Security in the Field] [Advanced Security in the Field]
Don't have them but can obtain them.

*Upload UN Security Certificate - Basic  
(Please put your last name in the filename)
Choose a file to upload:

*Upload UN Security Certificate - Advanced  
(Please put your last name in the filename)
Choose a file to upload:

Upload CV

*Upload CV   
(Please put your last name in the filename)
Choose a file to upload:

(*Mandatory fields)

I certify that, to the best of my knowledge, the information entered above is complete and accurate.

Copyright © 2015 Haiti Volunteers Form. All Rights Reserved.
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