Application for Research Appointments
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This form should be completed and returned to: Centre for Remote Imaging, Sensing & Processing (CRISP), National University of Singapore, Block S17, 2nd Level, Lower Kent Ridge Road, Singapore 119260.

1. GENERAL INFORMATION

Position applying for:

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Department:

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Please indicate how you came to know about the position being applied for*:

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Personal Contacts

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Advertisement in Newspapers / Journals / Other Publications:

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Others:

/ / / / / (Please specify Name of Publication) /

(Please specify)

/ Please indicate whether you are currently applying for a position in another department in the University*: / Please indicate details of any previous application:

Yes

/ Date:

No

/ (Please specify department) / Department:

2. PERSONAL PARTICULARS

Title and Full Name as in Passport/Identity Card (underline Surname/Family Name): / Name in Chinese characters, if applicable:
Prof / Dr / Mr / Mrs / Ms**
Postal Address: / Telephone Nos.:
(Office) / (Mobile)
(Home) / (Pager)
Confidential Fax No.:
Home Address (if different from Postal Address): / E-mail Address:
Nationality:
Singapore Permanent Resident*: / Yes / No
If yes, please attach a copy of Entry Permit and indicate:-
Date of Birth: / Country of Birth: / Date PR issued: / UIN:
Ethnic Group: / Religion: / For Singapore / Malaysian Citizens and Singapore PRs only
Identity Card No.: / Colour*: / Pink
Sex: / Marital Status: / Old Identity Card No.:
(For Malaysian Citizens Only) / Blue
Red
Names and Dates of Birth of Children, if applicable: / Passport No.: / Date of Issue:
Place of Issue: / Date of Expiry:
*Please as appropriate
** Please delete as appropriate
  1. EDUCATION (If applying for appointment as Research Assistant/Engineer or Research/Professional Officer, please also include a list of secondary/pre-university institutions attended and enclose the relevant certificates, where applicable)

Duration of Course /
Name of Institution
(list Universities and other Institutions attended) /
Country
/ Qualification Attained
(indicate class of degrees/diplomas and attach relevant certificates & transcripts)
From / To
  1. MEMBERSHIP OF PROFESSIONAL INSTITUTIONS OR SOCIETIES

Year / Name of Institution / Society
  1. SCHOLARSHIPS / AWARDS

Year / Type of Award / Awarding Body /
Period of Bond
(indicate if currently serving a bond)
  1. LANGUAGE PROFICIENCY

Written & Spoken / Proficiency
(indicate excellent/good/fair/poor) / Spoken Only / Proficiency
(indicate excellent/good/fair/poor)

7. EMPLOYMENT HISTORY

Present Appointment: / Date of Present Appointment: / Present Gross Annual Salary (Please specify currency):
Name & Address of Current Employer: / If appointed*: / resigning from present appointment
taking leave from present appointment
Duration of leave:
Earliest date available, if appointed:
Previous Appointments: (If Singapore citizen or PR, please include period served in National Service and attach a copy of NS certificate)
Duration / Employer (indicate name and address) / Position Held
From / To
  1. RESEARCH List the area(s) of your specialisation and current research:

  1. PUBLICATIONS (List publications in chronological order on a separate sheet. Please attach reprints of 3 of your best publications; in the case of theses and lengthy reports, submit an abstract.)

  1. RESEARCH ACCOMPLISHMENTS (List patents and highlight those that have led to commercialisation and/or high-tech start-up, commissioned reports, literary and artistic works, and other forms of publicly assessable output etc.)

* Please as appropriate
  1. REFEREES (Please ask your referees, who should be able to comment on your academic standing, professional competence and research ability, to send their confidential reports directly to the Director of CRISP within two weeks of the date of your application.)

Name / Appointment / Address/Confidential Fax No./E-Mail Address
1.
2.
3.
  1. COUNTRIES IN WHICH YOU HAVE RESIDED DURING PAST 5 YEARS

Duration / Address / Country
From / To
  1. FAMILY BACKGROUND

Full Name (Please also indicate name in Chinese characters, if applicable) / Date & Place of Birth / Nationality / Occupation / Present Address
Father
Mother
Spouse
  1. ANY OTHER INFORMATION
/ Any other relevant information (use separate sheet if necessary): /
  1. DECLARATION

I declare that the particulars in this application are true to the best of my knowledge and belief, and I have not wilfully suppressed any material fact.
/ / / / /

Signature of Applicant

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Date

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