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APPLICATION FOR ADJUNCT/ EXTERNAL LECTURER APPOINTMENTS
Please note the following instructions
A This form requires about 20 minutes to complete.
B You will need to have the following supporting documents to complete this form:
- NRIC (for Singaporean); Passport (for Non-Singapore Citizen);
- Spouse’s NRIC (for Singaporean); Spouse’s Passport (for Non-Singapore Citizen) if any;
- Educational Certificate(s)
- Colour Photograph
1 Before you complete the application form, you may wish to look at the latest Temasek Polytechnic Prospectus to identify the subjects or
modules you wish to teach.
2 Please return the completed form to the HR & Staff Development Department, TEMASEK POLYTECHNIC, 21 Tampines Avenue 1,
Singapore 529757.
3 Please enclose ONE photocopy of your highest educational qualification and/ or professional qualification in your area of expertise relevant to
the subject(s) you wish to teach.
4 False particulars or wilful suppression of material facts will render you liable to disqualification, or if appointed, to dismissal and/or
appropriate legal proceedings.
5 The Polytechnic regrets that it does not enter into correspondence with regard to the reasons for an unsuccessful application.
6 Serving employees in Government Service or Statutory Boards are required to seek approval from their employer for this appointment before
they can be appointed.
7 Please delete * whichever is not applicable.
1 FULL NAME as in NRIC/Passport (in Block Letters, Underline Surname). Where applicable, please provide name in Chinese
characters.
DR/MR/MRS/MDM/MISS/MS *
2 POSTAL ADDRESS
Internet E-mail Address :
3 DATE OF BIRTH :
4 NATIONALITY
HOME TEL NO / HANDPHONE / PAGER :
OFFICE TEL NO :
AGE :
Please complete where applicable
Singapore Citizen
Non-Singapore Citizen
Country of Birth (If Malaysia, please indicate the State)
Passport No :
Place of Issue :
NRIC No :
Date of Issue :
If applicable,
Date of Expiry :
Date Granted : (dd/mm/yyyy)
Singapore PR : Yes / No *
Previous Nationality :
If Yes, Date Granted SPR :
(dd/mm/yyyy)
UIN No :
5 RACE :
Updated on May 2006
RELIGION :
6 MARITAL STATUS : Single / Married / Separated / Divorced / Widowed*
If married, please provide particulars of Spouse.
Name :
Occupation and Employer :
Date of Birth :
Country of Birth :
Nationality :
NRIC No :
Indicate if Singapore PR : Yes / No *
Passport No. & UIN No :
7 SUBJECTS/MODULES YOU WOULD LIKE TO TEACH
Course
DAYS & TIME AVAILABLE TO TEACH (if applicable)
Subject/Module
Mon
Morning
Afternoon
Evening
Tue
Wed
Thu
Fri
Sat
8 EDUCATION
Name of College/ University attended
(State Country if not in Singapore)
Degree or
Professional
Qualification
Acronym Used for
the Qualification
State Major
Subjects (if any)
9 PRESENT EMPLOYMENT
Present Appointment:
Date First Appointed (dd/mm/yy)
Employer:
Address:
From
(Year)
To
(Year)
Short Description of your present job responsibilities
10 PREVIOUS WORKING EXPERIENCE (in chronological order and please attach a separate sheet if there is insufficient space)
Period of Employment
Name of Employer
Position Held, Brief Description
Date
Date
Commenced
Ended
of Duties & Responsibilities
11 Please answer the following questions by ticking the “Yes” or “No” in the right hand margin. Where the answers are “Yes” give details
below. If space is insufficient, please use a separate sheet of paper and attach it to this application.
Yes No
(i) Have you ever suffered or are you suffering from any pulmonary, nervous or mental trouble, previous prolonged illhealth neurasthenia or impediment in speech, hearing etc. ?
(ii)
Have you ever undergone any surgical operation or x-ray/medical investigation not of a routine nature?
(iii) Are you currently receiving or have you received any psychiatric treatment?
(iv) Do you have a criminal record in Singapore?
(v) Have you ever been convicted in a court of law in any other country (excluding parking offences or criminal records
disclosed above)?
(vi) Have you ever been dismissed or suspended from any employment?
(vii) Are you at present in debt?
(viii) Have you any obligations under promissory notes either as principal or surety?
Details on (i), (ii), (iii), (iv), (v), (vi), (vii) and/or (viii)
Updated on May 2006
12 DECLARATION
I declare that the above statements and those on attached sheets are true to the best of my knowledge and belief and that I have not
wilfully suppressed any material fact failing which I may be dismissed even if appointed.
___________________________
Signature of Applicant
Updated on May 2006
_____________
Date