APPLICATION FORM
I. GENERAL INFORMATION (in capital letters please)
Family name (Married women should give maiden name):
Given name(s)
Sex: Male/Female
Date of birth Place of birth
National registry number (Belgium) ...... -...... Nationality
Street House number Postbox number
City Postal code
Phone
Address for correspondence (if different from above)
Street House number Postbox number
City Postal code
E-mail address
Number of vacancy + Faculty of the vacancy
…………………/……………………………………… ……………………………………………………………………………………………………………
Name of the function of the vacancy
………………………………………………………………………………………………………………………………………………………………………………
Date, Signature,
Important:
· All correspondence and contact during the selection will be through e-mail. Please make sure it’s correct.
· If you are not a member of the VUB yet, your application form should be accompanied of a copy of your diploma and a filled-out declaration of external work (p.4-6). The situation on the declaration of external work should correspond with how it would be if you were appointed for the job you are applying for.
The VUB guarantees that the treatment of your application happens regarding the law on the protection of privacy of the 8th of December 1992. The personal information given by you will strictly be used in relation with your application. In case of your appointment as academic personnel, this information will also be used for further employer – employee communication
II. EDUCATIONAL QUALIFICATIONS
Secondary education (school(s), specialization, dates and qualifications):
Higher (incl. university) education (institution, specialization, dates and qualification incl. grade):
Title of thesis submitted for degree (where applicable):
Postgraduate qualifications other than doctorate:
Doctorate (incl. title of thesis):
Postdoctoral qualification (Aggrégation E.S. – Aggregatie H.O.), incl. title of thesis:
Any other qualifications
III. PROFESSIONAL EXPERIENCE
A. Not at the Vrije Universiteit Brussel: type of experience, where and when gained.
· Currently
· Previously
B. At the Vrije Universiteit Brussel
C. Other university experience, administrative or organizational responsibilities
D. Any other relevant experience (may be detailed in an addendum)
IV. ACADEMIC FILE
Every application form should be accompanied of:
· a brief curriculum vitae
· a motivation of the application
· an academic file with all relevant elements of
o the education file
o the research file
o the role in society’s radiation of the faculty and university
o commitment in faculty and university structures
o vision about the assignment
DECLARATION OF EXTRACURRICULAR ACTIVITIES
(DECLARATION OF EXTERNAL WORK)
Academic year …………………
I. Personal details
Family and given names:
Staff status:
VUB Faculty (or interfaculty dep't):
University hospital function (where applicable):
II. Members of the academic staff employed full-time
1. Other professional activities or other paid activities
c I have no other professional or paid activities
c I hereby apply for permission to carry out another professional or paid activity.
Name & address of the institution, organisation or place where the activity is carried out:
Description of the type of activity / activities:
Employment status (liberal profession, self-employed, salaried, education)
Scope (hours per week expressed as annual average per week or, for educational activities,
level, number of hours taught, fraction of a full-time position)
2. Other unpaid activities
c I have no other unpaid activities
c I carry out the following unpaid activities
Description:
Scope (hours per week expressed as annual average per week):
3. Specific functions under the Decision of the Flemish Government of 5 May 1993
I have the following function(s):
a) c Member of the European Parliament
c Member of the Belgian Parliament
c Member of the Flemish or other state legislature
c Member of the Commission of the European Communities
c Governor, vice-governor, permanent deputy, mayor, member of the municipal executive
or chair of the public welfare committee of a municipality of more than 50,000 inhabitants
Please specify:
b) c Exercising a liberal profession or other self-employed occupation
Which?
Are you a trainee in this profession?
Are you an appointed executive of a civil or commercial enterprise?
c) c Do you hold a teaching appointment in another university of other institute of higher
education in Belgium or abroad comprising more than two hours' teaching per week?
Scope of the appointment (level, number of hours taught, fraction of a full-time position):
Name and address of the institution:
III. Members of the academic staff employed part-time
1. Other professional activities or other paid activities
c I have no other professional or paid activities
c I have the following professional function or activity.
Name & address of the institution, organisation or place where the activity is carried out:
Description of the type of activity / activities:
Employment status (liberal profession, self-employed, salaried, education)
Scope (in half-days per week or, for educational activities, level, number of hours taught,
fraction of a full-time position)
2. Other unpaid activities
c I have no other unpaid activities
c I carry out the following unpaid activities
Description:
Scope (hours per week expressed as annual average per week):
I hereby declare that the above declaration with regard to other professional or paid activities and to
other unpaid activities is correct and complete.
I declare that I am prepared
(a) to request prior permission from the governing body of the University for any supplementary professional or other paid activity
(b) to notify the Rector immediately of any changes with regard to unpaid activity.
I certify the accuracy of the above declaration,
Date, ,Signature
1
Job application form