Form No. : 201 Version No: 01 Revision No.

: 01 Effective Date: 5th June, 2006

STUDENT AFFAIRS AND DEVELOPMENT DIVISION International Islamic University Malaysia

Date of receiving:

Photo

APPLICATION FORM
SEMESTER .. SESSION
INSTRUCTIONS To Applicant Please complete Section A, please specify the area in which you would like to apply for and attach any documents related to your expertise and experience in the area of your specialization. Please submit this form to the following address: Student Affairs and Development Division International Islamic University Malaysia 53100 Jalan Gombak, Kuala Lumpur SECTION A (To be completed by the Applicant) 1. Name : 2. Staff No./ Matric No : 4. Postal Address : 5. Fax : 7. Marital Status: Single/ Married 9. Telephone (Home) : 10. Language proficiency : (English) Excellent Good Fair Poor 13. Nationality : (Office): 11. Gender: 6. E-mail : 8. Date of birth: (H/P) : 3. IC No./Passport No.:

12. Kulliyyah/Division/Centre:

14. Present position: (In Student Development Division or Outside. Attach a separate sheet if necessary) .

15. Specialization & Expertise: . . 16. Job applied for: - Coordinator: - Chief Facilitator / Amir/ah: - Facilitator / Naqib/ah: - Parenting Lecturer: - Leadership Instructor: - Head Trainer: - Trainer: - Fardhu Ain Instructor: - Tahfiz Teacher: - Debate Trainer: - Skills Trainer: - Assistant Skills Trainer - Outside Coach: - Administrative Assistant: Please Provide the following information: (Attach a separate sheet if necessary) School/University/Institution Attended: 1. Year Academic Qualification

2.

3.

4.

Working experience, including any part-time or full-time employment in IIUM or outside (Attach a separate sheet if necessary). Applicants should attach their resume with this application Organization Position Duration

Any award/ outstanding achievement/ Projects/Activities that are related to the area of your intended work: (Attach a separate sheet if necessary)

Please explain in few sentences why you would like to be appointed in the work that you have applied for, (Attach a separate sheet if necessary):

Signature

Date

SECTION B To be completed by Assistant Director Date of receiving the application: ____________________________ - Modes of selection: a/ Direct Direct Selection By: - Director S-Dev - Head of Department: - Assistant Director b/ Recommendation Recommended Selection By: - Coordinator: - Amir/ah: - Head trainer: - Academician: - Administrator: - Other specify: ________________________________

- Date of selection: Direct/ Recommendation : _________________________ c/ Interview - Complete interview Check List Form - The Interviewing Panel: Date of Interview : _______________

a) c) e) - Status of Applicant: Successful KIV Rejected

b) d) f )

- Expected Date of Reporting for duty: ______________________

Remarks :

Signature and Stamp :

Date :

SECTION C To be completed by the Head of Department - Date of receiving the complete Application Form: ______________________ Remarks :

Signature and Stamp :

Date :

SECTION D To be completed by the Director - Date of receiving the complete Application Form: ______________________ Remarks :

Signature and Stamp :

Date :

OFFICE USE ONLY

Action Prepare offer letter Date reporting for duty Date Remarks