Advocating for the Rights of Migrant Workers in Malaysia

A capacity Building Program

(March 2017 – December 2017)

Candidates should fill out this form and email to

APPLICATION FORM

APPLICATIONS CLOSE: Sunday, 19th February, 2017

Applications will be acknowledged. Applicants will be notified of the outcome of selection soon after the closing date. Subject to the availability of places, applications may be considered after the closing date. Please contact DTP office for availability at

Please do not include any information that you think might affect your safety and security

YOUR DETAILS
1. First Name(s) / 2. Family Name:
3. Preferred name/known as:
4. Male / Female: / 5. Year of Birth:
6. Name of the organisation you work for:
7. Position in the organisation:
8. Email address 1:
9. Email Address 2:
10. Phone number at work:
11. Mobile number:
12. Fax number:
13. Postal Address 1:
14. City / 15. District / 16. Postal Code
17: Organisation’s website:
YOUR WORK AND EXPERIENCE
18. Present Role in Your Organisation/s:
(Please provide your title and a basic description of what you do)
19. Write a short summary of your role and other practical experience you have had relevant to this course:
(PLEASE LIMIT YOUR ANSWER TO 3 PARAGRAPHS. We are specifically interested in the work you do as an individual for your cause or organisation. We would like to know the activities you do on a day-to-day basis. What are your job responsibilities (give specific examples of programs, sectors/issues, approaches, level – eg: national, community)?
20. What knowledge/skills or networks would you most like to build through participating in this course?
21. Is there a specific case or issue relating to migrant workers that you are working on now that you think the course could help you with?Please describe?
22. What do you see as the biggest challenges to the human rights of migrant workers and their families in Malaysia and in the countries in which they work?
LANGUAGE
DTP/MFA are considering the need for interpretation in this course:
23. Do you feel confident to: (5 being confident)
o  Comprehend presentations in English 1 2 3 4 5
o  Participate in discussions/group work in English? 1 2 3 4 5
o  Read materials in English 1 2 3 4 5
If you are not confident in English, what is your preferred language of instruction?
Please Specify ______
CONSENT
24. Do you give us consent to use the information provided in this form to write a short biographical paragraph about you that will be given to trainers, participants and others for the purposes of informing them, advertising this training and in future DTP publicity material?
YES NO
25. Do you have concerns about your personal security that we should consider before using the information you have provided here?
YES NO
COMMITMENT
26. The course consists of five face-to-face sessions four days (20 days in total). This will be supplemented with tasks assigned on-line between the face-to face sessions. Can you commit to taking part in all five sessions and undertaking the assignments in between?
YES NO
TIMING OF MODULES
27. Do you have a preference for (please tick your preference):
□Modules that begin on Sunday and finish on Wednesday
□Modules that begin on Monday and finish on Thursday
□Modules that begin on Friday and finish on Monday
Other (please specify):

Date completed: ______