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PROFILE / PERSONAL HISTORY FORM

1. PERSONAL INFORMATION
Gender:
Family Name(s) (as in
passport):
First/Given Name(s) (as
in passport):
Middle Name (if any):
Date of birth:
Place of birth:
Nearest Airport:

Female

Nationality:
2nd Nationality (if any):
Passport Number:
Date of issue:
Valid until:
Place of issue:

Ekaterina
Isaeva

1990-10-27
Krasniy October, Tambov Mother's Full Name:
region
Father's Full Name:
Tambov

2a. OFFICE ADDRESS

PO Box:
Zip Code:
Town/City:
State:
Country:
Telephone (including
country/city codes):
Fax (including
country/city codes):
Email:
Web:

731410933
2013-10-16
2023-10-16
??? 68001
Isaeva Ludmila
Alexandrovna
Isaev Yuriy Vitalevich

2b. HOME ADDRESS


Tambov regional oncologic dispensary
clinical, Russia, Tambov,
Moskovskaya, 29 V,

Institute Name and


Address:

Russian Federation

Tambov
Russian Federation

ieu_777@mail.ru

Street Address
PO Box:
Zip Code:
Town/City:
State:
Country:
Telephone (including
country/city codes):
Fax (including
country/city codes):
Mobile:
Email:
Web:

7 953 701 33 19

3. LANGUAGE SKILLS
Mother Tongue:

RUSSIAN

Language
ENGLISH

Speak
L

Read
Write
W
W

Description
LIMITED (L) = Limited conversation, reading of newspapers,
routine correspondence.
WORKING KNOWLEDGE (W) = Engage freely in discussions,
read and write more complex material.
FLUENT (F) = Speak, read and write nearly as well as mother
tongue.

4. QUALIFICATION
Institute name, place and country

Degrees, diplomas, certificates


and academic distinctions

From

To

2014/05

2014/05

Training Centre "Amplitude", Sochi, Certificate of professional


Russia
development

Radiation safety and radiation


monitoring

2007/08

2012/07

Tambov State university named


G.R. Derzhavina, Tambov, Russia

Diplom

Medical physics

2013/11

2013/11

Russian Medical Academy of


Postgraduate Education, Moscow,
Russia

Certificate of professional
development

Clinical dosimetry

Generated on: 2016-07-19 07:24:21 by EKATERINA, Isaeva


Profile last modified on: 2015-10-01 09:40:12; Profile not yet submitted

Main course of study

List the specialties in which you consider yourself qualified:

5. EMPLOYMENT INFORMATION
1
Employment Period:

2012/08 - 2016/07

Employer (name and place):

Tambov regional oncologic dispensary clinical, Tambov

Title of position:

Radiology department

Type of Work:

Expert-physicist

Number and kind of staff


supervised:
Duties:

2
Employment Period:
Employer (name and place):
Title of position:
Type of Work:
Number and kind of staff
supervised:
Duties:

3
Employment Period:
Employer (name and place):
Title of position:
Type of Work:
Number and kind of staff
supervised:
Duties:

Generated on: 2016-07-19 07:24:21 by EKATERINA, Isaeva


Profile last modified on: 2015-10-01 09:40:12; Profile not yet submitted

6. HEALTH & RADIATION


I declare that I am in good health, free from infectious diseases and able physically and mentally to
carry out any relevant duties away from home.

Yes

No

If you have a physical disability or medical condition which might limit your ability to perform your assignment, please indicate the
limitations.

A certificate of good health dated not more than three months prior to training/meeting/expert mission must be submitted:

For trainings that are longer than 3 months, the trainee should undergo the medical examination prior the start of the training
and send the medical certificate to the responsible TC staff.
For all candidates over the age of 65.

Are you covered under a radiation surveillance programme in your country?

Yes

No

If yes, please provide the dose records for the last 5 years.
If no, please provide:

a medical certificate or personal declaration of health fitness to work with ionizing radiation (under the 'Radiation
Surveillance Remarks' box below),
information on your training in radiological protection (under the 'Radiation Surveillance Remarks' box below),
and if available the dose records of the last 5 years.

Radiation Surveillance Remarks


2012 year - 0,84 mSv
2013 year - 2,76 mSv
2014 year - 2,54 mSv
2015 year - 2,29 mSv
7. ADDITIONAL INFORMATION
List any significant publications or papers you have written which are relevant to your specializations:
I do not have publications.
List any lecturing experience you have (topics, duration):
I have not read the lecture , but I will try in the future.
List specific experience, not given above, related to the transfer of scientific and technical knowledge with special emphasis on
developing countries and on project management:
I do not have experience in similar projects.
List special qualifications and skills confirmed by licenses held and membership in professional, civic, public or international societies
or institutions relevant to your application:
Russian Medical Academy of Postgraduate Education, Moscow, Russia - Clinical Dosymetry
Training Centre "Amplitude", Sochi, Russia - Radiation safety and radiation
monitoring

Generated on: 2016-07-19 07:24:21 by EKATERINA, Isaeva


Profile last modified on: 2015-10-01 09:40:12; Profile not yet submitted