Pan Application Form - DOC by dij55092


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NETWORK International

Application for employment

Please complete form on line and email to PAN AP with copies to PAN UK and PAN Africa

Position: PAN International Assistant
Likely Location of Position: PAN Asia Pacific Office, Penang Malaysia

Closing Date: Friday 14 January 2005

Personal details:
Family name:                                            First name:

Date of birth:
                                                        Female /      male
Address:                                                Tel (daytime):

                                                        Tel (evening):


Nationality:                                            Do you require a work permit to work in Malaysia?

Secondary and further education:
Dates              Name and address of school/college            Examinations: A-levels, degrees, diplomas or other
                                                                 professional qualifications, dates and results
Languages:                          Level (basic/good/fluent):

Employment history: (Draw attention to relevant positions and attach CV)
Dates         Name and address of employer   Job title with main responsibilities   Reasons for leaving
              (Most recent first)

Activities and interests:
Relevant skills and experience (please draw particular attention those relevant for this position):

Why are you interested in this post at this point in your working life, and what do you feel
                makes you particularly suitable for this job?
(Please use this space to show how you meet the criteria in the job description. Give examples
from your experience where applicable. Continue on a separate sheet if necessary.)
Medical history:
Please state any serious or recurring illnesses, prolonged health-related periods off work etc.


Do you have any other medical conditions or any disability which could affect your performance in this job? If so, please
give details and alterations which PAN UK could make to overcome these.

References: (Please give at least two references, one of whom should be a previous employer)
Name:                                                        Name:

Position:                                                    Position:


                                                             Daytime tel no:

Daytime tel no:
                                                             Current or previous employer?

Current or previous employer?                                Please indicate if there is any problem in taking up this
                                                             reference before job offer:
Please indicate if there is any problem in taking up this
reference before job offer:

How much notice must you give your current employer?

I certify that the information on this form is to the best of my knowledge correct. I understand that any engagement
entered into may be subject to satisfactory references and successful completion of a probationary period.

(not essential)                                                      Date:

                                                                     Pesticide Action Network
                                                                     (International Assistant position)
                                                                     Copy to:

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