Form_AID_309-2_for_PSC_individual.pdf

OMB No. 0412-0579 Expiration Date: 05/31/2021

AID 309-2 Page 1 of 3

OFFEROR INFORMATION FOR PERSONAL SERVICES CONTRACTS WITH INDIVIDUALS

The Privacy Act Statement is found at the end of this form.

Section A – Offeror Information

1. Title of Solicited Position

Development outreach and & Communications Specialist

2. Offeror’s Proposed Base Salary

USD 823

3. Solicitation Number 72068719R10003

4a. Last Name Rarivoson

4b. First and Middle Names Volana

5a. Mailing Address volana.rarivoson@wfp.org

6. Phone Numbers (include area code if within the United States of America)

6a. Daytime 032 05 027 40

5b. City Antananarivo

5c. State

5d. Zip Code

6b. Evening 032 05 027 40

5e. Country (If not within the United States of America) Madagascar

7. Email Address (if available)

Section B – Work Experience Describe your paid and non-paid work experience related to this offer. Do not attach job descriptions.

Base Salary definition – basic compensation for services rendered, excluding bonuses, profit-sharing arrangements, commissions, consultant fees, extra or overtime work payments, overseas differential or quarters, cost of living or dependent education allowances.

1. Job Title (if Federal, include series and grade) Communications Assistant

2. From (mm/yyyy) August August 2006

3. To (mm/yyyy) Present

4.Base Salary $600 per month

5. Hours per week

6. Employer’s Name and Address World Food Programme Lot VB 71 GB Ambatoroka Antananarivo 101

7. Supervisor’s Name and Phone Number 7a. Name Moumini Ouedraogo

7b. Phone 032 07 137 01/09

8. May we contact your current supervisor? Yes X No

If we need to contact your current supervisor before making an offer, we will contact you first.

9. Describe your duties, accomplishments and related skills (if you need to attach additional pages, include your name, address, and solicitation number) For the past 13 years, I have been working as a Communications Assistant at the World Food Programme (WFP) in Madagascar, based in the Country Office Antananarivo, with frequent field missions to visit projects in drought-affected southern regions of Madagascar. As such, I have been able to extend my competences in Communications and develop skills in medias relations (national and international journalists) and donor relations. My work at WFP enables me to further extend my knowledge of the English language through working closely with WFP Regional Bureau and Headquarters in the field of reporting, as well as organizing and accompanying international donors and press visits to WFP projects in the field. I have contributed in the design of the WFP Madagascar Communications Strategy in support to the implementation of the Country Strategic Plan.

My main accomplishments also include the development of communications tools on WFP activities (fact sheets, posters, brochures) in Malagasy, French and English.

Section C – Additional Work Experience Continue on a separate page if required to list all employment relating to the duties of the position.

1. Job Title (if Federal, please include series and grade) Communications Assistant

2. From (mm/yyyy) October 1997

3. To (mm/yyyy) November 1998

4.Base Salary $40 per month

5. Hours per week

6. Employer’s Name and Address Cornell International Institute for Food, Agriculture and Development (CIIFAD) Ranomafana National Park

7. Supervisor’s Name and Phone Number 7a. Name Victoria Lines

OMB No. 0412-0579 Expiration Date: 05/31/2021

AID 309-2 Page 1 of 3

Madagascar 7b. Phone

8. May we contact your current supervisor? Yes x No If we need to contact your current supervisor before making an offer, we will contact you first.

9. Describe your duties, accomplishments and related skills (if you need to attach additional pages, include your name, address, and solicitation number) I was Responsible of Communications of the NGO Cornell International Institute for Food, Agriculture (CIIFAD) which implemented rural development projects in areas surrounding the Ranomafana National Park, in the south-east of Madagascar. The Communications activities consisted in sensitizing the communities on the importance of protecting the environment and preserving the biodiversity. I contributed in the production of different communications and community sensitization tools such as films, drama, audio materials and posters.

AID 309-2 Page 2 of 3

Section D - Education

1. Last High School (HS)/GED school. Give the school’s name, city, state, Zip code (if known), and year of diploma or GED received:

2. Mark highest level completed: Some HS HS/GED Associate Bachelor Master Doctoral

3. Colleges and universities attended.

Do not attach a copy of your transcript unless requested.

Total Credits Earned Semester Quarter

Major(s) Degree (if any), Year Received

3a. Name

City

State

Zip Code

3b. Name

3c. Name

Section E – Other Education Completed Do not list degrees received solely on life experience or obtained from schools with little or no academic standards.

Section F – Other Qualifications

License or Certificate Date of Latest License or Certificate State or Other Licensing Agency

1f.

2f.

Section G – Other Qualifications Offer-related training courses (give title and year). Offer-related skills (other languages, computer software/hardware, tools, machinery, typing speed, etc.). Offer-related honors, awards, and special accomplishments (publications, memberships in professional/honor societies, leadership activities, public speaking, and performance awards). Give dates, but do not send documents unless requested.

Section H - General

1a. Are you a U.S. citizen? Yes No 1b. If no, give the Country of your citizenship

1c. Are you a lawful permanent resident of the U.S.

(Green Card Holder)? ___Yes ___ No

2. Check this box if you are an adult male born on or after January 1st 1960, and you registered for Selective Service between the ages of 18 through 25 or have an exemption →

3. Were you ever a Federal civilian employee? Yes No → If yes, list highest civilian grade for the following:

3a. Series

3b. Grade

3c. From (mm/yyyy)

3d. To (mm/yyyy)

Section I – Offeror Certification

I certify that, to the best of my knowledge and belief, all of the information on and attached to this offer is true, correct, complete, and made in good faith. I understand that false or fraudulent information on or attached to this offer may be grounds for not awarding me the contract or for early contract termination after award, and may be punishable by fine or imprisonment. I understand that any information I give may be investigated.

1a. Signature 1b. Date (mm/dd/yyyy)

AID 309-2 Page 3 of 3

Privacy Act Statement

Authority: Foreign Assistance Act, Pub. L. 87-165, as amended; 48 CFR 37.104, Personal services contracts; 48 CFR Ch. 7, App. D, Direct USAID Contracts with a U.S. Citizen or a U.S. Resident Alien for Personal Services.

Purpose: This form collects personal information on offerors for USAID personal services contracts and is used to evaluate your qualifications for award of such a contract. This form is only valid with an OMB Number displayed in accordance with 44 USC 3506(c)(1)(B)(iii)(V).

Routine Uses: The personal information is used to examine and evaluate your qualifications for award of a specific personal services contract. The personal information is also used to determine the most appropriate offeror for such an award. The information may be shared outside of USAID to confirm your qualifications.

Disclosure: Providing personal information is voluntary. However, failure to provide any of the requested information may delay or prevent action on your offer for award of a personal services contract.

Public Burden Statement

We estimate the public reporting burden for this collection is estimated to average sixty (60) minutes per response, including time for reviewing instructions, searching existing data sources, gathering data and completing and reviewing the information. Send comments regarding the burden statement or any other aspect of the collection of information, including suggestions for reducing this burden via e-mail to pscmailbox@usaid.gov. Do not send offeror forms to this e-mail address; offerors must follow the instructions provided in the solicitation for this contract opportunity.

mailto:pscmailbox@usaid.gov