APPLICATION FORM
This application form does not substitute your normal CV.
Please do not delete or alter any item in this form.
1. Personal Information
Name:
Year of Birth:
Nationality:
Present Address:
recent
photograph
Telephone Numbers (Office):
(Mobile):
Fax:
E-mail:
Website:
Field of Specialization (tick one):
Analytical Chemistry
Physical Chemistry
Inorganic Chemistry
Organic Chemistry
2. Education and Employment Information
2.1 Education
PhD (Field):
Department:
City:
Year of Graduation:
Thesis Title:
MSc (Field):
Department:
City:
Year of Graduation:
Thesis Title:
BSc (Field):
Department:
University:
Country:
University:
Country:
University:
1
City:
Year of Graduation:
Country:
2.2 Employment Information
Position:
Department:
Institution:
Main duties:
Period:
Position:
Department:
Institution:
Main duties:
Period:
Position:
Department:
Institution:
Main duties:
Period:
Position:
Department:
Institution:
Main duties:
Period:
Position:
Department:
Institution:
Main duties:
Period:
Position:
Department:
Institution:
Main duties:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
2
3. Awards and Professional Recognition
3.1 Teaching/Research Awards
Institution:
Award:
Date:
Institution:
Award:
Date:
Institution:
Award:
Date:
Institution:
Award:
Date:
………./………./……….
dd/mm/yyyy
………./………./……….
dd/mm/yyyy
………./………./……….
dd/mm/yyyy
………./………./……….
dd/mm/yyyy
3.3 Research Fellowships
Institution:
Fellowship:
Period:
Institution:
Fellowship:
Period:
Institution:
Fellowship:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
3
3.3 Professional Memberships
Organization:
Period:
Organization:
Period:
Organization:
Period:
Organization:
Period:
Organization:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
4. Teaching
4.1 Teaching and Teaching Management
List of courses taught after PhD graduation.
Institution:
Course:
Dates:
Institution:
Course:
Dates:
Institution:
Course:
Dates:
Institution:
Course:
Dates:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
4
List of management roles in teaching after PhD graduation.
Institution:
Teaching management:
Period:
Institution:
Teaching management:
Period:
Institution:
Teaching management:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
4.2 Curriculum Design and Development
Institution:
Course:
Date:
Institution:
Course:
Date:
Institution
Course
Date
Institution:
Course:
Date:
Institution:
Course:
Date:
………./………./……….
dd/mm/yyyy
………./………./……….
dd/mm/yyyy
……/………/………….
dd/mm/yyyy
………./………./……….
dd/mm/yyyy
………./………./……….
dd/mm/yyyy
5
4.3 Student Advising
Institution:
Number of students advised:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
Institution:
Number of students advised:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
Institution:
Number of students advised:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
Institution:
Number of students advised:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
4.4 Supervision of Undergraduate Research Projects
Institution(s):
Total number of undergraduate projects: None
1–5
6 – 10
11 – 20
≥ 21
5. Scholarly Activities and Achievements
5.1 Refeered Journal Papers
List five (5) papers that best represent your research area
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
6
5.2 Participation in Conferences
List five (5) conference presentations that best represent your research area
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5.3 Funded Research Projects
Title of research project:
Research team (put asterisk mark ,*, next to your name if Principal Investigator):
Funding agency:
Research grant in USD:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
Title of research project:
Research team (put asterisk mark ,*, next to your name if Principal Investigator):
Funding agency:
Research grant in USD:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
Title of research project:
Research team (put asterisk mark ,*, next to your name if Principal Investigator):
Funding agency:
Research grant in USD:
Period:
from ………./………./………. to ………./………./……….
dd/mm/yyyy
dd/mm/yyyy
7
5.4 Supervision of Postgraduate Students
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
6. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
7. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
8. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5.5 Examination of Theses
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5.6 Other Relevant Scholarly Achievements
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
8
6. Service
6.1 Administration
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
6.2 Professional Service
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
6.3 Public Service
1. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
9