institute for infocomm research job application form - A*Star

INSTITUTE FOR INFOCOMM RESEARCHJOB APPLICATION FORMImportantPlease attach a copy of:1. Detailed resume2. A copy of NRIC/Passport, Reference Letters, Qualification Certificates, Detailed Transcripts, Detailed CV3. For applicants with PhD qualifications, you may be requested to forward a copy of your publication papers.Original copies should not be forwarded but must be produced later when required for verification.Position Applied For :Area of Interest/ Specialisation :Source of Info on Position Applied For :Pls. attachyour recentphotographherePersonal Particulars (Please write in CAPITAL letters/ tick the correct boxes)Title: Dr Mr. Ms Family Name :First Name : Second Name :Alias/Other Name (if any) :MaritalStatus : Single Separated Widowed Married DivorcedDate of Birth : Date of Marriage : Religion : Gender : Female(dd/mm/yyyy) (dd/mm/yyyy) MaleRace : Country of Birth : State of Country :Nationality : Singaporean Singapore PR Foreigner :Pls. specify your NationalityID Details NRIC No.:(for Singapore Citizen only) Singapore Permanent Resident No. :Your current CPF Contribution Rate : % Foreign Identification No.(for Foreigner only) : Passport No. :Issue Date(dd/mm/yyyy)Expiry Date(dd/mm/yyyy)Home Country Contact Address :Telephone DetailsHome : Pager : Fax No. :Office : Handphone : Email Address :Mailing Address (if it differs from Home :Country Contact Address)Telephone DetailsHome : Pager : Fax No. :Office : Handphone : Email Address :Postal/Zip Code :Postal/Zip Code :HR_JOB_01_v2.1Page 1 of 5

Particulars of Spouse & ChildrenName NRIC No./ FIN Nationality Date of Birth(dd/mm/yyyy)SpouseChild 1Child 2Child 3Child 4GenderOccupationEducational BackgroundFormal Education (pls. start with the latest/most recent education)School/Institution Country Duration(dd/mm/yyyyy to dd/mm/yyyy)Qualification NameClassObtained(if any)MajorPart Time/Full Time* For Masters Degree, please indicate whether it is by coursework or researchScholarship Details (if any)Scholarship Name : Qualification Name :Name of Sponsoring Organisation: No. of Yrs of Bond :Bond Start Date : Bond End Date :Short Courses/Training Attended (please start with the latest/most recent courses attended)Name of Course/Training Date obtained Training ProviderInformation Technology (IT) Experience/Knowledge/Skills(for non-IT positions, please state your software knowledge/experience, e.g. MS Office Word.1 2 3 4HR_JOB_01_v2.1Page 2 of 5

General InformationLanguage ProficiencyProficiencyLanguage Read Written SpokenEnglish Excellent Good Excellent Good Excellent Good Average Poor Average Poor Average PoorOther Language 1: Excellent Good Average Poor Excellent Good Average Poor Excellent Good Average PoorOther Language 2 : Excellent Good Average Poor Excellent Good Average Poor Excellent Good Average PoorNational Service Details (For Singaporean only)Have you completed your National Service? YesNoIf no, please state your Run-Out-Date(ROD) :(dd/mm/yyyy)Professional MembershipName of InstituteAssociation Type(e.g. IT)CountryMembership Type(e.g. ordinarymembership)Entry Date(dd/mm/yyyy)Expiry Date(dd/mm/yyyy)Your Hobbies/Interests1 2 3 4Present & Past Employment (Please start with present/latest employment)Name ofOrganisationCountryIndustryTypeDesignationFrom(dd/mm/yyyy)To(dd/mm/yyyy)Last DrawnMonthlySalaryFull Time/Part-time/TempReason(s)for LeavingTotal Length of Work Experience: Year(s) Month(s)Notice Period Required to Leave Present Employment :Month(s)Page 3 of 5HR_JOB_01_v2.1

RemunerationPer MonthPer AnnumYour Current Base Salary Your current annual salary includes : AWS or 13 th Month Variable Bonus,please state no. of months :Other Allowances:Your Current Total RemunerationYour Expected Salary Your expected annual salary includes : AWS or 13 th Month Variable Bonus,please state no. of months :Other Information1. Have you been or are you suffering from any physical impairment, illness or disease? Yes NoIf Yes, please specify :2. Have you ever been discharged or dismissed from the services of your previous employers? Yes NoIf Yes, please specify :3. Have you ever been convicted in a Court of Law in any country? Yes NoIf Yes, please specify :4 Have your even been detained by the police of any government? Yes NoIf Yes, please specify :5 Have your ever worked in Institute for Infocomm Research (I²R)? Yes NoIf yes, please tick the appropriate box :From(mm/yyyy)To(mm/yyyy) I 2 R staff Temp Staff Intern/IA Student Contractor (Contract for Service)6 Have your ever been shortlisted for a position in Institute for Infocomm Research (I²R)? Yes NoIf yes, please state the position applied :7 Do you have family members or relatives working in I²R? Yes NoIf yes, please state the name/s and position/s of your relative/s :Contact Person for Emergency CaseName of Contact Person :Contact Person Address :Telephone DetailsHome : Pager : Fax No. :Office : Handphone : Email Address :Relation with you :Postal/Zip Code :HR_JOB_01_v2.1Page 4 of 5

Referees (Please provide two referees who know you in your employment or private life (non-relatives) and towhom reference may be made. One of the referees must be someone who knows you during your past/presentemployment)1.Name Address ContactNo.OccupationNo. of YearsKnownRelationwith You2.Declaration of ApplicantI voluntarily give Institute for Infocomm Research (I²R) the right to make a thorough investigation of any past employmentand activities, agree to co-operate in such investigation, and release from all liability or responsibility all persons, companiesor corporations supplying such information.I agree that the entire contents of this application form, as well as the report of any such examination, may be used by theCompany in whatever manner it may wish.I declare that the above information and documents attached hereto are true to the best of my knowledge and belief, andthat I have not wilfully suppressed any material facts.I understand that any false answers or statements made by me on this application or any supplement thereto, or inconnection with the above investigation, will be sufficient grounds for immediate termination of my services.Date: ________________________Signature of Applicant: ________________________** Kindly return the completed form to the address below and indicate the positionyou are applying for at the top left hand corner of the envelope **Human Resource DepartmentInstitute for Infocomm Research (I²R)1 Fusionopolis Way, #21-01 Connexis SouthSingapore 138632Fax: (65) 6776 1378Email Address: joinus@i2r.a-star.edu.sgHR_JOB_01_v2.1Page 5 of 5