Office use only:
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PASS Facilitator Application Form: 2020 team recruitment

PHAR1812 BASIC PHARMACEUTICAL SCIENCE

Section 1
Family Name / First Name
Telephone (Mobile) / Preferred Name
Telephone (Alternative) / Gender / Female / Male
USyd Email Address:
Citizenship / Visa number and expiry
(For international students)
Date of birth(DD/MM/YY) / Student ID (SID)
Course (E.g., B.Phar):
What was the first semester and year of enrolment into your current degree? / S1  or S2  / What is your expected LAST semester and year of your current degree / S1  or S2 
Year: / Year:
Semester Postal Address / Permanent Postal Address
(If different to your semester postal address—we need this to send any training materials to you during the Summer break, should you be successful)
Section 2
  1. I have achieved a “Credit” grade average overall in my Uni studies to date.
/ YesNo 
  1. I have achieved a “Distinction” or “High Distinction” grade in the Unit(s) of Study I am applying to facilitate in.
/ Yes No  Anticipated
  1. I can attend the 3 days of training (February 11th,12th, 13th2020)
(attendance is compulsory if you are to be considered for a PASS Facilitator role) / YesNo 
  1. I can commit to working for minimum one semesterand will be on campus a minimum of 3 weekdays during each semester
/ YesNo 
If you answered no to question 3, please explain why. (e.g. applied for
internship, other work commitments, finish degree etc)
Section 3
Referees: Provide contact details for two referees. It is recommended that you alert your referees to the content of your application and that you select referees who can directly comment on your ability to meet the criteria.
NB: This is compulsory for your application to be considered
Name of referee and title / Relationship to you / Phone contact details
1.
2.
Employment History: If relevant, list up to two positions you have held.
Date of Employment / Name of Employer / Description of responsibilities
Extracurricular activities: Describe the activities that you are currently involved in—including volunteer activities, if relevant.
Activity / organisation / Description of your activities, responsibilities & achievements / Hours per week / Will this activity continue in 2020?
1.
2.
3.

Application checklist

A complete application consists of: Please tick 

  1. An application form (Do not submit an additional curriculum vitae—it will not be considered) 
  2. A “Statement Addressing the Selection Criteria” (up to but no more than 2 pages) 
  3. A copy of your academic transcript (printed from Sydney Student) 
  4. Submission of three hard copies of each of the above components 
  5. A passport style photograph attached/ stapled to each of the three copies of your application 

I agree that PASS Management may monitor my academic record prior and (if my application is successful) throughout my employment with the PASS Program.

I certify that the information provided in this application is complete and accurate.

Signed: ______Date: ______

Important notice
Applicants who do not follow the submission process precisely cannot be considered
Applications close on Friday September 13th 2019 at 10am sharp.
Late applications will not be considered.
For more information first visit the web
or contact Jessica Morr