Tan Sri Hasmy Agam

JOB APPLICATION FORM

Position Applied For

Photo (optional)

Personal Data

First Name(s) (underline the one normally used): Last Name/Surname ( in Capital Letters):

Maiden name (if any):

Date of Birth: Place of Birth ( City, Country):

Nationality(ies) ( Present/Previous):

Optional :

Sex Female Male

Marital status Single Married Divorced/ Separated

Child(ren) Yes No

Permanent Address: Correspondence Address ( if different) :

Phone Number: :

Mobile Number: :

Email Address: :

International Office: Rue de Varembé 1, 2nd Floor, 1202 Geneva, Switzerland Tel: +41 (0)22 740 2947 Fax: +41 (0)22 740 2948 Regional Office: 66/2 Pan Road, Silom, Bang Rak, Bangkok 10500 Thailand Tel: +66 (0)2 6379126-7, Fax: +66 (0)2 6379128 Webpage: http://www.forum-asia.org, Email: [email protected] Education and Training (University Degree, Postgraduate Studies, Language or IT Courses, Specific Skills Workshops/Diploma) Dates Name/Address of Institution or Details of Course Qualifications Course Provider Attended Gained From:

To: From:

Note (if any):

Publication(s) (if any)

International Office: Rue de Varembé 1, 2nd Floor, 1202 Geneva, Switzerland Tel: +41 (0)22 740 2947 Fax: +41 (0)22 740 2948 Regional Office: 66/2 Pan Road, Silom, Bang Rak, Bangkok 10500 Thailand Tel: +66 (0)2 6379126-7, Fax: +66 (0)2 6379128 Webpage: http://www.forum-asia.org, Email: [email protected]

Professional Experience

(Starting with the most recent, list IN REVERSE ORDER. Please describe any previous experience (including Internships) you have had, giving full details of your duties.)

1. Name of Employer: Name of Business: Address of Employer: Name/Position of Supervisor:

Contact Details: Brief Description of Your Duties:

Exact Title of Your Position:

Period of Employment from: till: 2. Name of Employer: Name of Business: Address of Employer: Name/Position of Supervisor:

Period of Employment from: till:

Please feel free to add more columns if you have more experience to be stated.

International Office: Rue de Varembé 1, 2nd Floor, 1202 Geneva, Switzerland Tel: +41 (0)22 740 2947 Fax: +41 (0)22 740 2948 Regional Office: 66/2 Pan Road, Silom, Bang Rak, Bangkok 10500 Thailand Tel: +66 (0)2 6379126-7, Fax: +66 (0)2 6379128 Webpage: http://www.forum-asia.org, Email: [email protected] Other Skills

Languages (Please indicate your mother tongue and also level of proficiency: Fluent, Good, Intermediate, Basic)

Language Understand Read Write Speak

IT skills (Please indicate Level of expertise in programme(s) or specific system(s))

References

Name/Title of Reference: Name of Reference:

Relationship with the reference (current employer):

Contact Address: Contact Address: Phone Number: Phone Number: Email Address: Email Address: When may we contact the person? When may we contact the person?

(Before or after short listing): (Before or after short listing):

Other Information

Please tell us more about yourself (e.g. hobbies and participation in social activities) and relate also your working or extra-curricular experience to the job descriptions. Moreover, tell us how your abilities fit into our requirements and why are you interested in this position.

If appointed, when can you start? Please state clearly.

I certify that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief.

Signature: Date:

Please return/e-mail complete form to

[email protected]

Office Address:

Asian Forum for Human Rights and Development (FORUM-ASIA)

66/2 Pan Road, Silom, Bang Rak, Bangkok 10500 Thailand Tel: +66 2 6379216-7, Fax: +66 2 6379218 E-mail: [email protected]