| Date of Registration |
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| Position Desired |
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| Present Occupation |
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| Desired Work Status |
full-time
part-time |
| Please complete the Contact Information section.
Remember, this form is equivalent to a resume, and complete contact information is
important. |
| First Name |
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| Middle Initial |
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| Last Name |
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| Address |
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| City |
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| Prov/State |
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| Country |
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| Postal/Zip Code |
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| Telephone |
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| E-mail |
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| How did you find out about us? (Please indicate
source) |
| HD Faculty's Partner or Affiliate |
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| Other (please specify) |
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| Language Ability: |
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I speak and write English fluently |
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I speak and write French fluently |
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I speak and write Spanish fluently |
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I also speak and write |
Are you
licensed to work in: (please check all that apply) |
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Canada |
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United States |
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Other (specify) |
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Diploma/Assoc. Degree: |
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Bachelor's Degree: |
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Master's Degree: |
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Ph.D Degree: |
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Other Degree: |
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Professional
Membership(s)/Licenses |
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Specify professional memberships,
affiliations, licenses, etc., |
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Employment
Eligibility: (please check all that apply) |
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The United States |
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US Citizen |
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Valid US Green Card Holder |
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Valid US Work Visa Holder (specify type) |
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Canada |
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Malaysian Citizen |
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Malaysian Landed Immigrant Status |
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Valid Malaysian Work Visa Holder (specify type) |
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Other Country/Countries, namely: |
| Country |
Citizen/Holder of Valid Work Permit (specify) |
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Please indicate the number of
years you have worked full-time in your speciality:
(HD Faculty requires job applicants to have a minimum of 4 years working experience) |
4 years
5 years
6 years
7 years
8-10 years
11-15 years
Over 15 years |
Please paste your resume here |
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