UNIVERSITI TUNKU ABDUL RAHMAN
Job Recruitment Online Application Form
of Part-Time Lecturing
 
Position Applied For  * Department / Faculty *
PERSONAL PARTICULARS
Title    Full Name    *
I.C. No.
(Malaysia Identity Card No.)		 - - New Old
Passport No.
Date of Birth / / (dd/mm/yyyy)* Gender Female    Male
Age * Race
Nationality * Marital Status
Country
 
Residential Address
Address *
City / Town * Postal Code *
State / Region
Country *
Same as above
Permanent Address
Address
City / Town Postal Code
State / Region
Country
 
Telephone
Home * Mobile
Office
Fax
Email *
 
IMMEDIATE FAMILY PARTICULARS
  Spouse Father Mother  
Name
Occupation Field
Designation
Employer's Name
Employer's Address
Contact No
Children / Siblings
Name Age Gender Relationship Status
 
Name Age Gender Relationship Status
 
EDUCATION BACKGROUND
Institution (In chronological order, starting with the most recent / highest qualification)
Name of Institution *
Country *
Level *
Major *
CGPA
Duration    to    * e.g : 01/2004 (mm/yyyy)
 
Name of Institution Country Level   Major CGPA From To
 
Title of Doctorate Thesis / Dissertation
 
Title of Master Dissertation
 
Title of Undergraduate Academic Paper / FinalYear Project
 
Publications
 
  Max (250 characters)
 
Professional Qualification / Membership
Name of Professional body
Country
Qualification / Membership
Membership Number
Duration From to
 
Name of Professional Qualifacation / Membership Membership No. Duration
From To
 
Special Awards (e.g. Honorary Doctorate, Dean's List etc)
Name of Award Date Awarded
 
Name of Award Date Awarded
 
LANGUAGE PROFICIENCY
(Proficiency is rated from 1 to 10, 10 being the hightest level)
Language Spoken Written
 
Language Spoken Written
 
SKILLS
Skill
   Proficiency
 
Skill Proficiency
 
Typing Speed wpm Shorthand wpm
Driving License Class e.g : D, B2
 
PROFESSIONAL TRAINING
Title Date
 
Title Date
 
WORK EXPERIENCE
Designation
Name of Employer
Last Drawn Salary  
Employed From to e.g : 01/2004 (mm/yyyy)
Employer's Address
Reason for Leaving
 
Designation Employer Date
 
WORK EXPECTATION
Notice of resignation required for present employment month(s)
Willing to relocate? Yes No
Current Salary
Expected Salary *
 
GENERAL INFORMATION
Please tick (ü) the appropriate box Yes No If yes, please give details
Have you ever been implicated or convicted in any commercial, criminal or civil law proceedings?
Have you ever been dependent on any kind of drugs/alcohol?
Have you ever had any serious illness/disease?
Has any member of your family ever had any serious illness/disease?
Do you have any disablilities, physical or otherwise?
Are you currently pregnant? (for female candidates)
Are you member of any club / association?
Do you have any relative/friend currently working in UTAR?
       
REFEREES
(Please provide names of three referees who are not relatives)
No. Name Designation Company Address Tel No.
1.
2.
3.
 
Person to Contact in case of Emergency
Name Address Tel No Relationship
 

I hereby declare that all information provided in this form is true and correct. If any of the information I have furnished either intentionally or unintentionally is found to be untrue, I understand that Universiti Tunku Abdul Rahman reserves the right to terminate my appointment or take any other action as it deems appropriate.