CONFIDENTIAL	

For Official Use Only:

College: ___________________

Subject: ___________________

Teacher No. ________________

ID card seen by: _____________

  

Part-time Teachers Application Form
兼職教師職位申請表

1.	Please complete this form in BLOCK LETTER and in full to provide basic information in a standard format.  You may, if you wish, attach a full curriculum vitae. 
請以正階填寫。 閣下亦可附上履歷一份。
2.	The information provided will be used for all appropriate purposes within the School and retained in the School part-time teachers database. It may also be disclosed to parties authorized to process the information for appointment or it may be referred to other unit(s) within the School for consideration of other suitable vacancy(ies). Unsuccessful applications will be retained for a maximum period of twelve months. 
申請人所提供的資料將予保密，並只供有關人員或部門作招聘用途 。申請表格將於12個月後銷毀。
3.	The completed application form should be sent to the Teacher Support Unit, Registry Affairs Office, HKU SPACE, 9/F, T.T.Tsui Building, The University of Hong Kong, Pokfulam Road, Hong Kong
申請表格可郵寄香港薄扶林道香港大學徐展堂樓9樓 - 香港大學專業進修學院學務部「教師支援組」收。

Post Applied for 申請職位 	 Reference No. 空缺編號 : _______________________

Programme / Subject 課程/學科  		

Part 1  Personal Particulars 個人資料

*Title :	 Prof. 	 Dr. 	 Mr. 	 Mrs. 	 Ms. 	 Miss 	Name in Chinese :			
  稱謂	教授 	博士 	先生 	太太 	女士 	小姐 	中文姓名 (if applicable 如適用)	

Surname姓氏 : 	 	Given Name(s)名字 (in full): 	
Date of Birth 出生日期 (optional 非必要):                     
HKID No. 香港身份證號碼 : 		
Passport No. & Country of Issue 護照號碼及簽發國家 ( for applicants without HKID 適用於沒有香港身份證的申請人): 
__________________________________________________________
Correspondence Address 通訊地址 :  			
	
				Contact Tel. No. 聯絡電話 : 	
Fax No. 傳真號碼 (if any): 		 E-mail Address 電郵地址 :	

* Please tick as appropriate 請於適當空格加號

Part 2 Qualifications (please provide details in descending chronological order) 資歷 ( 請順序列出 )

Academic Qualifications 學歷 

Award Institution 
頒授院校名稱	Qualifications and Subjects 
所得資格/文憑/學位 及 修讀範圍 	Year of Award 
頒授年份	

			

			

			

Professional Membership 專業資格 (if applicable 如適用) 

Name of Professional Body 
學會/專業機構名稱	Name of Award
認可程度/資格	Year of Award 
頒授年份	

			

			

			

Current and Recent Teaching/Working Experience 工作及教學經驗
Dates 日期
(Month/year)	
Organisation 
工作機構/僱主名稱	
Position 
職位 	
From 由 	To 至			

				

				

				

Language (Medium of Instruction) 可操教學語言 

Please specify 請註明	

Other Subject(s) Applicant wants to Teach 台端 希望任教之其他科目

Please specify 請註明		

Other School Appointments 其他於本院之職位 

Please indicate if you have been appointed as *External Examiner / Academic Assessor / Member of Programme Validation Panel / Member of Programme Review Panel of HKU SPACE.  
如台端曾任本院之 *校外考試主任 / 校外評核主任 / 課程評審小組成員 / 課程檢討小組成員， 請註明。

* please delete as appropriate 請刪除不適用者

Other Relevant Information 其他資料

Declaration on Conflict of Interest 聲明

If you have any close friends and/or relatives working in the School, please give their names in full and state their relationship to you. Close relatives include spouse, parents/parents in law, brothers/sisters and their spouses, children and their spouses.
如台端有親友於本院工作，請提供其姓名及與其之關係。 直系親屬包括配偶、個人或配偶之父母、兄弟姊妹及其配偶、子女及其配偶。

I, the applicant, certify that the information I have given is correct and complete to the best of my knowledge.  
本人為申請人，謹此証明提供之所有資料為事實之全部，並無虛言。

Signature 簽署: ___________________________________     Date 日期: _________________________________________