UNIVERSITI TUNKU ABDUL RAHMAN
Job Recruitment Online Application Form
(Academic Staff)
 
Position Applied  * Department / Faculty *
UTAR Kampar UTAR Bandar Sungai Long
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 *
Award Classification *
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
 
 
Professional Qualification / Certification
*(Qualification /certification requires to practice in certain jobs or profession such as Accountant, Engineer, Architect, Counsellor, Microsoft Certified Trainer, etc.)
Name of Professional Body
Country
Qualification / Certification
Certification No.
Duration From (dd/mm/yyyy) to
 
Name of Professional Country Qualification / Certification Certification No. Duration
From To
 
Professional / Association/ Society Membership
Name of Professional Body / Association / Society
Country
Type of Membership
Membership Number
Duration From (dd/mm/yyyy) to
 
Name of Professional Body/Association/Society Country Type of 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 highest level)
Language Spoken Written
 
Language Spoken Written
 
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 *
 
A. RESEARCH
A1. Research Projects/Grants & Funding
Note: Please list research projects completed and in-progress. Highlight projects with international collaboration. If you are doing your postgraduate study by research, please provide details of research project as well. Use separate sheet, if necessary.
Title of Project
Details of Grants/ Awarding Agency
Colleagues/ Collaborators involved
Role in Project (Team Leader/ Member)
Duration (dd/mm/yyyy) to
Amount (RM)
 
Title of Project Details of Grants/ Awarding Agency Colleagues/ Collaborators involved Role in Project (Team Leader/ Member) Duration Amount (RM)
Start End
Please provide related supporting documents for the Research Projects/ Funding
 
B. PUBLICATION & PATENT
B1. Journal Publications
Note: All publications accepted/published are to be listed. Use separate sheet, if necessary.
Description of Paper (Author(s), Paper Title, Name of Journal / Vol./No./Pg. No., Year)
Name of Publisher
Database in which Journal was listed
Status of Paper
 
Description of Paper (Author(s), Paper Title, Name of Journal / Vol./No./Pg. No., Year) Name of Publisher Database in which Journal was listed Status of Paper
Please provide related supporting documents for the journal papers.
 
B2. Conference Presentations
 
Description of Paper (Author(s), Paper Title, Name of Conference / Venue / Dates, Pg. No.)
Conference Database Listed
[Oral / Poster][Invited Paper/ Refereed Paper/ Abstract]
Role of Presentation [Keynote/ Session Chairman/ Presenter]
 
Description of Paper (Author(s), Paper Title, Name of Conference / Venue / Dates, Pg. No.) Conference Database Listed [Oral / Poster][Invited Paper/ Refereed Paper/ Abstract] Role of Presentation [Keynote/ Session Chairman/ Presenter]
Please provide related supporting documents for the conference papers.
 
B3. Patent
 
Title of Patent
Author(s) [according to author sequence, including yourself]
Date Filed/ Date Granted [Reference No] (dd/mm/yyyy)
Short Description
 
Title of Patent Author(s) [according to author sequence, including yourself] Date Filed/ Date Granted [Reference No] Short Description
Please provide related supporting documents for the patent.
 
B4. Book/Book Chapter Publications
 
Description of Book/Book Chapter (Author(s), Title, Book/Book Chapters, Editor(s), Publisher, Pg. No., Year)
Status of Publication
 
Description of Book/Book Chapter (Author(s), Title, Book/Book Chapters, Editor(s), Publisher, Pg. No., Year) Status of Publication
Please provide related supporting documents for the books / book chapters.
 
B5. Creative Output/Other Publications
 
Description of Publication (Author(s), Publication Name, Name of Publisher, Issue/Vol./Series/Pg. No.,Year)
Type of Publications / Circulation
Remarks
 
Description of Publication (Author(s), Publication Name, Name of Publisher, Issue/Vol./Series/Pg. No.,Year) Type of Publications / Circulation Remarks
Please provide related supporting documents for the creative output / publications.
 
B6. Involvement in Research Centres (especially at University level)
 
Centre
Role
Remarks
 
Centre Role Remarks
Please provide related supporting documents for the involvement in Research Centres.
 
C. POSTGRADUATE SUPERVISION
C1. Supervision of Postgraduate Students
Note: If postgraduate student supervised is not UTAR student, please provide letter of appointment from institution concerned as documentary evidence.
Name of Student
Degree
Name of Institution
Duration (dd/mm/yyyy)
to
Role (Main Supervisor/ Co- Supervisor)
Status of Student Progress
 
Name of Student Degree Name of Institution Duration Role (Main Supervisor/ Co- Supervisor) Status of Student Progress
Start Completed Date (if applicable)
 
D. TEACHING AND UNDERGRADUATE SUPERVISION
D1. Teaching Duties
 
Subject Taught
Institution
Level of Teaching
Role
 
Subject Taught Institution Level of Teaching
 Role
Postgraduate Professional Bachelor Sole Shared
 
D2. Supervision of Undergraduate Students
 
Title of Project (academic year)
Involvement as
Sole/Main/Co-supervisor
Name of Student
 
Title of Project (academic year) Involvement as
Sole/Main/Co-supervisor		 Name of Student
 
E. CONSULTANCY/ EXTERNAL CLINICAL PRIVATE PRACTICE
Note: Only consultancy works/clinical services completed or in-progress are to be listed.
E1. Consultancy Projects (including Clinical Consultancy)
 
Name of Project / Client Details/ Role in Project/ Others
Duration (dd/mm/yyyy)
to
Contribution (Role)
%
Amount Involved (RM)
 
Name of Project / Client Details/ Role in Project/ Others Duration Contribution Amount Involved
Start End Role %
Please provide related supporting documents for consultancy work/ External Clinical Private Practice
 
F. ADMINISTRATIVE SERVICES
F1. Services to the University (Administrative Position/Coordinator/Committee Member)
 
Name of University/Committee
Description of Role
Date / Duration (dd/mm/yyyy)
to
 
Name of University/Committee Description of Role Date / Duration
Note: Only position held/ administrative duties/ contribution in committees/ organizing of conferences/ industry liaison and coordination work are to be listed
 
F2. External Services to Profession/Discipline
 
Name of Organization /Association/ Journal/ Conference/ Committee
Role
Date / Duration (dd/mm/yyyy)
to
 
Name of Organization /Association/ Journal/
Conference/ Committee		 Role Date / Duration
Note: Please provide supporting documents on appointments/positions held
 
F3. External Services to the Community/Society/ National and International Organizations
 
Name of Organization /Association
Role
Date / Duration (dd/mm/yyyy)
to
 
Name of Organization /Association Role Date / Duration
Note: Please provide supporting documents on appointments/positions held
 
F4. Membership of Professional Societies and Associations (if applicable)
 
Name of Organization /Association
Role
Membership No:
Date / Duration (dd/mm/yyyy)
to
 
Name of Organization /Association Role Membership No: Date / Duration
Note: Please provide supporting documents on membership
 
G. HONOURS/ AWARDS/ RECOGNITION
G1. Honours/Awards/Recognition
 
Description of Role
Awarding Body
Date (dd/mm/yyyy)
 
Description of Role Awarding Body Date
 
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 illness/disease?
Has any member of your family ever had any 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?
Do you own any business / company whether fully or partially?
       
REFEREES:
Kindly give details of referees. The candidate is advised to approach the referees for their consent and to provide the necessary information to facilitate the referees to write their report. Kindly inform the referees that they are to send in the referee’s report directly to the Division of Human Resource, UTAR.
Referee 1:
Name:
Designation:
Correspondence Address:
Telephone (Office):
Telephone (Mobile):
Email:
 
Referee 2:
Name:
Designation:
Correspondence Address:
Telephone (Office):
Telephone (Mobile):
Email:
 
DECLARATION:

I hereby declare that all information provided in this form is true and correct. If any of the information furnished by me, 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.

I understand and agree to the University using and processing my personal data as contained in this form. I have read, understood and agreed to the Personal Data Protection Statement of the University (click to read PDP statement).