[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

Guide to General Public Service

Place to affix photo

Form Number 1— Form Regarding Situation

 

  1. Biographical details:

National identification number: ------, Birth certificate number: ------

Name: ------

Surname: ------

Father’s Name: ------

Date of Birth: 13 /   /

Marital Status: ------ Single ------ Married

  1. Religion: Islam Shia ------ Islam Sunni ------ Christian ------ Jewish ------ Zoroastrian ----Other ------
  2. Educational status: ------ Secondary student: In-person education/after-hours study------ University student ------ Degree completed ----- exclusion, Left school, or suspended ------

Date of degree completion:  13 /   /, Date of exclusion: 13 /   /, Date of withdrawal from study: 13 /   /, Date of suspension 13 /   /

Degree Certificate:                  Major:                 University Name:        

  1. Skills and specialization: If you have an ability, skill, or specialization in scientific, cultural, sports, technical, or other areas, please write down your speciality in detail in this section:
  2. Prior Service Record.

In case you have a prior service record pertaining to the urgent period and have been excluded from service for legal reasons, complete the following items.

Date deployed to serve: 13 /   /, Specific name of the service unit:                       Date of release from service: 13 /   /, Unit of service: (Army. Sepah. NAJA. Ministry of Defence) Reason for Release:

  1. Application Type:

Deployment to Service:             Suggested Date of Deployment:

Note: The date of deployment for eligible applicants will be determined by the Department of Public Service based on the capacity of the educational centres and the needs of the armed forces.  The date of your deployment will be tentative only and will not entitle you to any rights.

 

Medical Exemption: Type of Illness              (List type of your illness in Persian)

Guardianship Exemption: Type of Guardianship        (Write according to the grids on pages 15 and 16)

Other Exemptions: Type of Exemption                     (Write according to the grids on pages 17,

18, and 19)

  1. Training:  Have you completed the additional “Basiji” training:  Yes       No
  2. Address of Residence:  Province            Town  

Address:

Postal Code:                       Phone:             Municipal Code:

Mobile:                  (Listing of your mobile number will be considered as an acknowledgement that you accept the texting charges for updates on the latest status of your application.)

Email:

  1. Account Number in Sepah Bank

       Place for the Applicant’s Signature and the Date of Completion of the Form