“Home for Innovative Researchers and Academic Knowledge Users (HIRAKU)” CONSORTIUM

APPLICATION FORM FOR 7th JOB OPENINGS OF THE CONSORTIUM (Fiscal 2017)

1.Name in Full 2. Sex
(Family) (First) (Middle)
3.Date of Birth:
/ /
Day Month Year / 4. Nationality
4. Present Address (Zip code: )
E-mail: Phone: Fax:
5. Affiliation Address (Zip code: )
E-mail: Phone: Fax:
6.Academic Degree
Type (PhD, etc): Date Obtained (D/M/Y) / /
Title of thesis :
Institute: (Country)
7. ExpectedResearch Field and Workplace in the Job Openings
8.Higher Education (Start from the latest one.)
Name of University / Institution / Location / Degree / Field / Completion Date (Month, Year)
9.Previous Employment and/or Professional Research Experience(Start from the latest one. In particular, describe clearly when and where you have research experiences outside of Japan.)
Name of Institution / Location / Position / From–To
10. List of Research Achievements
*Attach copies of major publications up to 5.
*State important information, e.g. authors (all), title, name of the journal, vol, pp., year, refereed(or not)
* If there are more thanten authors, you can omit authors name other than first author, corresponding author and your name. In this case, state the number of the authors and your order on the author list.
(1) Books
(2) Reviews
(3) Original papers
(4) Proceedings of international conference
(5) Patents (held or applied, names of all patentees)
(6) Grants (name of grant, year, research theme, amount of grant, leading researcher or collaborator)
(7) Special remarks (award, fellowship, invited lecture, etc)
11. Outline of Past Research (Up to 4 pages including figures, free format, using 10 points or larger fonts)
12. Research Plan at the Consortium (Up to 4 pages including figures, free format, using 10 points or larger fonts)
-Describe your research plan for five years to come including collaborations with diverse actors.
13. Aspirations for the contribution to science, technology and innovation (1 page, using 10 points or larger fonts)
-It is able to add your research career plan, which should include your activityin the Consortium (e.g., research, training and collaboration).
14. List of References (We may directly contact them.)
Reference 1
Name:
Affiliation/Title:
E-mail:
Phone:
Reference 2
Name:
Affiliation/Title:
E-mail:
Phone:

I certify the above information to be accurate and correct.

Date:

NAME (Print) :

Signature:

(Notes)

  1. Please sign this form.
  2. All documents including your publicationsshould be submitted in PDF format with the file name Consortium(7)_(last name_first initial of applicant) (e.g., Consortium(7)_(Einstein_A)) to the following e-mail address:

E-mail:

  1. Attach copies of your major publications up to 5 after this page or another file.

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