Please Complete in English (Type Or Print) Using Extra Pages Where Necessary

BIOTEC NATIONAL CENTER FOR GENETIC ENGINEERING AND BIOTECHNOLOGY POSTDOCTORAL FELLOWSHIP APPLICATION FORM Photograph Please complete in English (type or print) using extra pages where necessary 1” A. PERSONAL DATA First name: ……………………………………………………………………………………………………………… Surname: ……………………………………………………………………………………………………………… Address: ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… E-mail…………………………………………Telephone…….………………………………………… Date of Birth: (D/M/Y) ………………………………….. Age: ………………….. Sex (M/F): ………………… Place of Birth: ………………………………………….. Nationality: ……………………………………………… Marital Status: …………………………………………………………………………………………………………… B. EDUCATION Academic qualifications: (University or equivalent) Years attended Major fields of study Degree GPA From / To …………………………… …………………… …………………………….. …………… …….. …………………………… …………………… …………………………….. …………… …….. …………………………… …………………… …………………………….. …………… …….. …………………………… …………………… …………………………….. ...………… …….. …………………………… …………………… …………………………….. …………… ……..

C. SCIENTIFIC PUBLICATIONS List original papers in peer reviewed journals and for the past five years only: ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

Postdoctoral Fellowship Application Form D. EMPLOYMENT Present position: …………………………………………………………………………………………….……… Institution: …………………………………………………………………………………………………… Dept./Faculty: ……………………………………………………………………………………………………… Address: ……………………………………………………………………………………………………… ………………………………………………………………………..…………………………… Tel: ……………………..…………. Fax: …………………………. E-mail: ………….………… Current research and areas of interest: ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… Institutes of work since end of formal education: Research Institution or University From / To Duties / Responsibilities ……………………………………. …….………………….. …………………………………… ……………………………………. …….………………….. …………………………………… ……………………………………. …….………………….. …………………………………… ……………………………………. …….………………….. …………………………………… ……………………………………. …….………………….. ……………………………………

E. LANGUAGES Mother tongue: ………………………………………………………………………………………………………… Read Comprehend Speak Write Other languages easily not easily easily not easily easily not easily easily not easily

F. PREVIOUS FELLOWSHIPS List previously held fellowships from other organizations: Organization From / to Research ……………………………………… …………………………..……….. ………………………… ……………………………………… …………………………..……….. ………………………… ……………………………………… …………………………..……….. ………………………… ……………………………………… …………………………..……….. ………………………… ……………………………………… …………………………..……….. …………………………

Postdoctoral Fellowship Application Form G. OTHER AWARDS Yes No If yes, please give details below: …………………………………………………………………………………..………….. …………………………………………………………………………………..…………… H. AREA OF RESEARCH IN WHICH YOU INTEND TO WORK ………………………………………………………………………………………………………… ……………………………………………………………………………………………………….. I. EXPERTISE ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… J. THREE REFERENCES 1. Name………………………………………………………….……………………………………………………………… Contact address………………………………………….…………………………………………………………………. Telephone………………………………………….…………………e-mail……………………………………… 2. Name………………………………………………………….……………………………………………………………… Contact address………………………………………….………………………………………………………………. Telephone………………………………………….…………………e-mail …………………………………………… 3. Name………………………………………………………….……………………………………………………………… Contact address………………………………………….…………………………………………………………………. Telephone………………………………………….…………………e-mail ………………………………………………… K. Additional Documents 1 Transcript and certificate of doctorate

2 Abstract of Dissertation

3 Statement of Intent

4 Three Recommendation Letters (should be sent directly to BIOTEC by the person providing the reference) Please submit application form as well as additional documents to: Post Doctoral Scholarship Program BIOTEC Research Support Division National Center for Genetic Engineering and Biotechnology 113 Phahonyothin Road, Klong1, Klong Luang, Pathumthani 12120 Thailand Tel: (66-2) 564 6700 ext. 3154, Fax: (66-2) 564 6707 e-mail: [email protected] Signature: ………………………………………………………….. Date: …………………………………………………………………

Postdoctoral Fellowship Application Form