PART-TIME APPOINTMENT SCHEME APPLICATION FORM (For Undergraduate and Graduate Students working on part time basis)

Instructions to apply: Approach the department staff in charge of Part-Time Appointment Scheme on the details and availability of the position you are interested in; Fill in the details required in Part 1; Submit the application to the department.

RO.1022/03

PART 1 :

To be completed by Student

A. Student Particulars
Name (Underline surname) Dr/Mr/Mrs/Mdm/Miss Birth Date (dd/mm/yyyy) Department Student No. Programme Type Undergraduate/Grad Coursework/Research* Degree Gender Male / Female*

Citizenship (Please tick accordingly [ ] ) [ ] Singapore Citizen (NRIC No.: ____________________ ) [ ] Singapore Permanent Resident (NRIC No.: ____________________ )
Date of Issue: ________________ _______ )

[ ] International Citizen (FIN No: _________________________ ) (Nationality:

Singapore Mailing Address: Contacts Telephone No.: Handphone No: Postal code (

Email Address:

B. Proposed Appointment: UST / USR / GST (Scheme _____) / GSR (Scheme _____)* Period [(Please state semester (e.g. Sem I, 2007/08) or
period from: ____ to ____ (dd/mm/yyyy)].

Duties (Please give a brief description)

Total no. of proposed hours:

. Yes / No*

Are you currently holding another part-time appointment in NUS? If Yes, please state: Total no. of working hours per week : _________________

Current Rate of payment : $ ________________

C. For Graduate Research Students Only

If you are an NUS Research Scholarship holder, please state: Award start date:
(dd/mm/yyyy) Award expiry date: (dd/mm/yyyy) Is your proposed appointment at the same department as your registered department? Yes / No* Please obtain the approval/signature of your research supervisor below and hand this form to the processing officer of the Department where you will be employed.

I agree to the proposed appointment. Name of Supervisor: Department: * To delete as appropriate. Signature : Date:

Signature of Student: ______________________________________

Date: __________________

PART 2 :

To be completed by Supervisor/Principal Investigator employing the Student (for USR/GSR scheme only)

I recommend/do not recommend* the proposed appointment. If appointment is under research grant (please ensure availability of sufficient funds), to state: WBS No: Project title: Project start date: End date:

Type of grant: * University/NSTB/NMRC/Others (please specify):

Name: Department:

Signature : Date:

PART 3 :

To be completed by Approving Officer (Faculty/Department where student is employed)

I approve/do not approve* the proposed appointment. Rate of payment: $ per hour Total remuneration: $

Name: Designation:

Signature : Date:

* To delete as appropriate.

C:PTT-APPLICATION FORM/LE/07122010