Campus Diepenbeek, Agoralaan - gebouw D

B - 3590 Diepenbeek
Phone +32 11 26 80 03
Fax +32 11 26 80 19
e-mail: jobs@uhasselt.be
www.uhasselt.be

Application form for vacancies of

Academic Staff

Reference of the mandate for which you are applying: .................................................................

(mandate ............./ .................. / ............... )

Identification

Surname/familyname:
.............................................................................................................................................

Christian name (= name by which one is generally known):

.............................................................................................................................................

Mailing address:

- street and number: ............................................................................................................

- postal code and city: ..........................................................................................................

- telephone (area code and subscriber's number): (...................)..............................................

Domicile:

- street and number: ............................................................................................................

- postal code and city: ..........................................................................................................

- telephone (area code and subscriber's number): (...................)..............................................

E-mailaddress: .......................................................................................................................

Place and date of birth: ........................................................................................................

Sex: .....................................................................................................................................

Nationality: ..........................................................................................................................
2.

Academic titles, degrees and study results

Please fill out all your study results after high school. Don't forget to include the titles of your master's thesis or
final examination paper, as well as the disciplines, the dates and the institutes where they were obtained. In case
an institute does not evaluate the results per academic year, please mention the results and the date per
examination.
For postdoctoral positions: please indicate the names of the supervisors and co-supervisors of your Ph.D.-thesis.
A copy of your Ph.D.- thesis can be asked for during the interview.

Please a copy of your diploma and also a list of courses and your results per course should be included

University + country Degree name per year Grade Grade Year

of study (discipline) in %
Bachelor years

1st year

2nd year

3rd year

Master years

1st year

2nd year

3rd year

Other academic degrees at bachelor or master level (including teacher training)

BA or University + country Title or degree Grade Grade Year
MA (discipline) in %

Final examination paper

(title and supervisor)...................................................................................................
................................................................................................................................
................................................................................................................................
Ph.D.
(title).........................................................................................................................
................................................................................................................................
................................................................................................................................
(supervisor)...............................................................................................................
(institute where Ph.D. was obtained).............................................................................
(date of Ph.D.)............................................................................................................
(grade obtained).........................................................................................................
 3.

Career

1. Present position:.................................................................................................................

Starting date:.................................. Institute: ....................................................................

........................................................................................................................................

2. Previous positions
(chronological list of the positions, with clear indication of the duration and the name of the
institute)
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

Overview of scientific activity and publications. Please highlight your publications on

the web of Science:

Overview of teaching activities:

4.

Other activities and experiences

.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

I apply for the following vacancy

(Please mention the description and the references of the vacancy (vacancies) you want to apply for)
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

Other information, useful to your application

.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

Declared at ......................................... on ...................................................................20......

(signature)

To be returned to:

Hasselt University
Rectoraat
Campus Diepenbeek
Agoralaan - gebouw D

BE- 3590 Diepenbeek

e-mail: jobs@uhasselt.be

Application form AAP