CONFIDENTIAL 341/1111

APPLICATION FORM

for Professoriate, Academic, Professional and Senior Administrative Staff Grades

Post applied for: Ref. no.:

Department:

Surname: Given name(s) (in full):

Title: Prof. / Dr. / Mr. / Mrs. / Miss / Ms. * Name in Chinese (if applicable):

Date of birth: Nationality: H.K.I.D. Card no.:

Address for correspondence:

Contact no.: Office telephone no.:

Confidential fax no.: E-mail address:

Research interest/field (if applicable):

I declare that the information I have given in this application is correct and complete to the best of my knowledge and belief. I attach sheets of supplementary information.

Date Signature

Name and Initials

EDUCATION BACKGROUND

PROFESSIONAL MEMBERSHIP

WORK EXPERIENCE (in descending chronological order)

Present salary (if applicable; if not, please quote last salary):

Next incremental date (if applicable):

If appointed, when would you be able to assume duty?

香港大学博士后申请表