SOUTHEAST UNIVERSITY

House 64/B, Road 18, Block B, Banani, Dhaka 1213 Tel: 55034125-28, 55034136, 55034192
Fax: 880-2-9892914, E-mail: info@seu.ac.bd

APPLICATION FORM OF PART TIME/ ADJUNCT / VISITING FACULTY

POSITION

1. General Information:

Name (in Block Letter)

Present Address
01 (one) recent
Date of Birth
Passport size
Photograph
Mobile No.

Email

Department/Discipline

2. Educational Qualifications:

Title of Results
Type of Name of
Degree with Class/Division/ Year of Board/ Position Award/
the the
Major & CGPA (Out of Passing University (If any) Scholarship
Degree Institution
Minor ….)
SSC

HSC
Bachelor’s
Degree
Master’s
Degree (1)
Master’s
Degree
(2)/
M. Phil
PhD
Other
Degree (s)

Notes:
 Result must be endorsed.
 Photocopy of Certificates and Transcripts to be included.
 May include more rows if required.

Page no. 1 of 4
 SOUTHEAST UNIVERSITY
House 64/B, Road 18, Block B, Banani, Dhaka 1213 Tel: 55034125-28, 55034136, 55034192
Fax: 880-2-9892914, E-mail: info@seu.ac.bd

2. Professional Qualifications:

Title of the Period

Name of the
Certification/ Location Result Duration
Institution
Degree From (Date) To (Date)

Note: May include more rows if required.

3. Language Proficiency:

Name of the Exam

Reading Writing Speaking Overall Score
(IELTS/ TOEFL etc.)

Note: May include more rows if required.

4. Work Experience:
a. Summary (Only active teaching experience at University Level):

Name of the
Designation Department/Discipline From (Date) To (Date)
University Duration

Total

Note: May include more rows if required.

b. Summary (Other experiences/ corporate experiences if any):

Institution/
Designation Department From (Date) To (Date) Duration
Organization

Total

Page no. 2 of 4
 SOUTHEAST UNIVERSITY
House 64/B, Road 18, Block B, Banani, Dhaka 1213 Tel: 55034125-28, 55034136, 55034192
Fax: 880-2-9892914, E-mail: info@seu.ac.bd

Note: May include more rows if required.

5. Publications (If any):

Sl Journal, Put (√) in the relevant column No. of First Author

no. Title of the Article ISSN, Single Multiple Local Intl. Authors or not
Volume, Author Author (Give Tick)
Issue, Page
etc.
1.
Yes / No

2.
Yes / No
3.
Yes / No
4.
Yes / No
5.
Yes / No

Number of Articles Single-Authored =

Multiple-Authored =

Total Publication =

Note: May include more rows if required.

6. Personal Information:

Father’s Name Occupation

Mother’s Name Occupation

Marital Status Nationality

Permanent
Address

7. References:

Reference: 01
Name
Designation 
Organization 
Phone (Off) 
Mobile 

Page no. 3 of 4
 SOUTHEAST UNIVERSITY
House 64/B, Road 18, Block B, Banani, Dhaka 1213 Tel: 55034125-28, 55034136, 55034192
Fax: 880-2-9892914, E-mail: info@seu.ac.bd

Email 
Address

Reference: 02

Name
Designation 
Organization 
Phone (Off) 
Mobile 
Email 
Address

8. Certificate of Authenticity:

I, the undersigned, certify that, all information stated in this form is true and complete to the best
of my knowledge. I understand that any willful misstatement described herein may lead to my
disqualification.

___________________________
Signature of the Candidate

Page no. 4 of 4