Cocu Pttime Appform
Cocu Pttime Appform
Cocu Pttime Appform
Version No.
Revision No.
Effective Date
:
:
:
:
06
01
00
24th April 2014
SEMESTER .. SESSION /
INSTRUCTIONS
Please complete Section A, please specify the area in which you would like to apply
for and attach resume, photo and any documents related to your expertise and
experience in the area of your specialisation. Please submit this form to the
following address:
Centre for Credited Leadership and Soft Skills
(formerly known as Credited Co-Curricular Activity Centre, CCAC)
3. MyKad / Passport:
4. Postal Address:
.....................................................................................................................................
.....................................................................................................................................
5. Fax:
6. E-mail:
8. Date of Birth:
Single / Married
9. Telephone:
(Home): _______________ (Office): _______________ (H/P): _______________
10. English Proficiency:
Excellent
Good
Fair
Poor
Male / Female
12. Kulliyyah/Division/Centre:
13. Nationality:
14. Present Position (in IIUM or Outside. You may add attachment if necessary):
15. I am applying for...
Study Circle Packages
Chief
Facilitator
Skills Packages
Facilitator
Trainer
Assistant
Trainer
Debate Packages
English
Debate
Trainer
Arabic
Debate
Trainer
Presentation
Skills
Trainer
Public
Speaking
Trainer
Others
Far Ayn
Instructor
Taf
Instructor
Leadership
Trainer
Parenting
Lecturer
Admin.
Asst./
Graduate
Assistant
17. Educational History (Please provide the following information. You may attach
separate sheets if necessary).
Year
School/Institution/University
Academic
No.
Attended
Qualification
From Until
1.
2.
3.
4.
18. Working Experience (including any part-time or full-time employment. You may
attach separate sheets if necessary).
No.
Organisation
Position
Duration
1.
2.
3.
4.
19. Any award / outstanding achievement / projects / activities that are related to
the area of your intended work? (Attach a separate sheet if necessary)
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
20. 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:
: _____________________
Date of Interview
: _____________________
Action
Prepare offer letter
Date reporting for
duty
Date
Remarks
PIC