Sie sind auf Seite 1von 4

Applicant Information

A. Professional 1. Position applying for: 2. Name: 3. Contact no. & email address: 4. Academic record (start with highest degree) [Add additional row(s), if necessary]: # Name of the Institution Degree/ Level (Please mention subject in Honours & Masters level) Passing Year Class/Division/ Grade Please attach recent passport-size photograph here

5a. Employment record (start with current job) [Add additional row(s), if necessary]: # Name of Organization Duration From To Designation Reason for leaving

3-5 key responsibilities:

3-5 key responsibilities:

3-5 key responsibilities: 5b. Experience of voluntary work, if any [Add additional row(s), if necessary]: # Name of Organization Duration From To Designation Reason for leaving

6. Total length of experience (total duration at 5a): 7. Your current/last drawn gross monthly salary (in Tk.): 8. Explain the reason(s) for gap in service (if more than three months):

-1-

Printed on 13/6/2013 at 17:22 a6/p6

Applicant Information
9. Training Record [Add additional row(s), if necessary]: # Title/Subject of Training Duration Provided by Location

10. Language skill [Add additional row(s), if necessary]: Writing # Language Averag e Good Very Good Excellent Averag e Good Very Good Excellent Speaking

11. Computer skill: Please specify by putting a cross (X) under appropriate program. List any other program you are skilled in under the column Other. MS Word MS Excel MS PowerPoint MS Access SPSS STATA Other

12. Any other relevant special skills: 13. List of publication(s)/Report(s), (If any): 14. Any special achievement/distinction:

-2-

Printed on 13/6/2013 at 17:22 a6/p6

Applicant Information
B. Personal 1. Full name: 2. Fathers name: 3. Mothers name: 4. Date of birth: 5. Sex: 6. Nationality: 7. Religion: 8. Ethnic identity: 9. Disability (if applicable): 10. Marital status:

11. List of immediate family members employed in TIB, if any [Add additional row(s), if necessary]: # Name of relative Designation at TIB Place of posting

12. In your professional career were you ever terminated on disciplinary ground? If yes, give details: 13. Were you ever convicted of a criminal offence? If yes, give details: 14. Address (including contact no. & email): Permanent Address Mailing Address

15. Reference (with full contact details and email): Referee 1 Referee 2

16. Authentication: a) Do you certify with full confidence that the information provided are authentic and accurate (put X to indicate)? Yes No

-3-

Printed on 13/6/2013 at 17:22 a6/p6

Applicant Information
b) Do you confirm that you have read the TIB Code of Ethics (http://www.ti-bangladesh.org/TIBCodeofEthics.pdf) and if appointed, do you agree to uphold it fully (put X to indicate)? Yes No

17. Signature: .......................................................................

Date: ...................................

-4-

Printed on 13/6/2013 at 17:22 a6/p6