This form may take you 15 minutes to complete.

You will need the following information to complete the form:

Your identity card number (applicable for Singapore!alaysia "iti#ens and S$%&
Your '() number and date of issue (applicable for S$%&
Your *() number and date of issue (applicable for )on+Singapore
"iti#ens%esidents&
Your family members, personal details
Your educational records and -ualifications and date obtained
Your employment records including your last drawn gross monthly salary
Personal Particulars Form (Research Staff Positions)
$lease refer to http:www.ntu.edu.sghr for guidelines on applications of %esearch staff appointments. $lease submit your completed form with full
curriculum .itae to: /ffice of 0uman %esources (%esearch 1ppointments&2 )anyang Technological 'ni.ersity2 1dministration 3uilding2 4e.el 52 56
)anyang 1.enue2 Singapore 789:9;< *a= (75& 7:91+9856 or email to : )T'%esearch>ntu.edu.sg.
1. ?@)@%14 ()*/%!1T(/)
$osition applying considered for :
%esearch 1ssistant
School : S"@4S@ $lease state earliest date to
commence work : 1
ST
/ctober A615
$lease indicate where you came to know about the position being applied for:
)T' Bebsite .
1re you currently applying for a position in another School in )T'C Yes2 please specify School: DDDDDDDDDDDDDDDDDDDDDDDDDDDDD
A. $@%S/)14 $1%T("'41%S
*ull )ame as in $assport (dentity "ard (underline Family Name) :
Er !r !rs !iss
Sagunthala Ee.i Fandasamy
Ee.i
)ame in "hinese characters2 if applicable :
)1
0ome $ostal 1ddress :
65+A152 3lk A86 3ukit 3atok @ast 1.enue2 Singapore
756A86
Eate of 3irth :(dd/mm/yy) 10/03/1988 @thnic ?roup : (ndian
"ountry of 3irth : (ndia )ationality : (ndian
?ender : *emale

!arital Status : !arried

/ffice Tel )o: 0ome : 0andphone :G75 9;778A58 @+mail 1ddress :
sagukandasamy>gmail.com
*or Singapore "iti#en :
(dentity "ard )o. :
)1
*or Singapore $ermanent %esident
($lease attach a copy of @ntry
permit& :
'() : )1
Eate of S$% issued : (ddmmyy&

*oreigner : Type of Singapore (mmigration $ass you are currently holding:
Eependant,s $ass
*() )umber : ?869A::1% Eate of @=piry : 1A68A617
$assport )o. : 4956;5;1 Eate of @=piry : 1565A6A5
*ull+time national ser.ice records : ((f male Singapore "iti#en or $ermanent %esident of Singapore2 please attach a copy of the "ertificate of "onductSer.ice&
0a.e you been e=empted from full+time )ational Ser.iceC Yes)o ((f yes2 please attach a copy of the e=emption notice&
"ountries in which you ha.e resided during the past 5 years :
*rom (ddmmyy& To (ddmmyy& 1ddress
)1 )1 )1
8. *1!(4Y 31"F?%/')E
*ull )ame Eate(ddmmyy& H
$lace of 3irth
)ationality /ccupation @mployer $resent 1ddress
*ather Fandasamy )1 (ndian )1 )1
!other Ihothi )1 (ndian )1 )1
Spouse Sara.anan
%amanathan
A;6519;5 (ndian
@ngineer "1T@%$(441%
!1%()@ 1S(1
$1"(*(" $T@ 4TE
65+A152 3lk A86 3ukit 3atok @ast
1.enue2 Singapore 756A86
Personal Particulars Form (Research Staff Positions)
"hild(ren& )1 )1 )1 )1 )1
5. @E'"1T(/) (4ist institutions uni.ersities attended. $lease attach rele.ant copies of certificates transcripts.&
*rom To Schools (nstitutions 'ni.ersities attended Jualifications /btained
(e.g. 0onours Eegree&
Iuly A61A !ay A618 !anikam @ducational (nstitute $udukkottai2 (ndia 3achelors of @ducation
Iune A66; 1pr A616 'ni.ersity of !adras2 (ndia !.S".2 (ndustrial !icrobiology
Iune A665 1pr A66; E%.!?% Ianaki college for women2 "hennai2 (ndia 3.S".2 !icrobiology
4anguages ($lease state languages and proficiency le.el i.e. e=cellent2 good2 fair2 poor&
Britten : ?ood Spoken : ?ood
5. @!$4/Y!@)T 0(ST/%Y ($lease list in chronological order H pro.ide documentary e.idence where.er applicable&
Eates
$osition held
/rganisation,s @mployer,s
)ame and 1ddress
4ast Erawn 3asic
!onthly Salary
%eason for 4ea.ing
Ser.ice *rom To
Iune
A618
1pril A615
3iology
(nstructor 4ab
Super.isor2
Faraikudi.
Sel.a Kinayagar 0igh School2 (ndia ()% 15666!onth Eue to !arriage
!ay
A616
1ugust
A611
4ab 1ssistant ?lobal 3iolim2 1yana.aram2 "hennai ()% ;666!onth $ersonal %eason
Iune
A669
1pril A616 (ntern Tamil )adu "o+operati.e !ilk $roducers )1 )1
7. "01%1"T@% %@*@%@@S ()ame 8 persons who are not your relati.es&
)ame /ccupation Years known 1ddress Tel "ontact @mail 1ddress
Er $alaniswamy Suresh Fumar
%HE Scientist 8 years Singapore !obile: G75 98969;91
Er. )a.een Fumar @lumalai
%HE Scientist 8 years
1ustraliaG71 5566;A1;7
)ishanthi %amasamy
%esearch Scholar 7 years (ndia!obile: G91 9;;58:5775
:. /T0@% ()*/%!1T(/)
$lease answer the following -uestions. (f the answer is LYesL to any of the items below2 please gi.e details on a separate sheet of paper.
a 0a.e you any criminal recordC
)o
)o
)o
)o
b 0a.e you e.er been dismissed2 discharged or suspended from employmentC
c 0a.e you e.er had2 or are you suffering from any:
+ physical impairmentC
+ diseaseC
+ mental illnessC
)o
d 1re you currently ser.ing a bond or a moral obligatory ser.iceC
)o
)o
e Eo you ha.e any relati.e or friend presently working in the 'ni.ersityC
(f yes2 please state hisher name2 relationship and department:DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
;. E@"41%1T(/)
( declare that all the particulars gi.en in this application are true to the best of my knowledge and belief2 and ( ha.e not wilfully suppressed any material
fact.
E1T@ : (ddmmyy& A59A615 S(?)1T'%@ :
Sagunthala Ee.i Fandasamy
)ote: *alse particulars or suppression of material facts will render you liable to dis-ualification and if appointed2 to dismissal