Kwame Nkrumah University of Science and Technology
Kumasi, Ghana

Senior Member Online Application Form

Application for Appointment as:
in the College/Faculty/Department/Institute/Centre of:
1. PERSONAL PARTICULARS  
(a) Surname [USE BLOCK LETTERS]
(b) First or other Names
(c) i. Present Address in full
ii. Email
(d) i. Telephone No
ii. Fax
(e) Nationality:
     i. Nationality at birth (if different)
     ii. Surname at birth (if different)
  * iii. If naturalised citizen, give number and date of certificate

and the name in which it was granted
  * iv. Aliens registration number
(f) Date and place of birth
(Date of birth once given shall not be subject to any amendment(s) in future for any reason whatsoever)
(g) Hometown
(h) Whether single, married or widow/widower
**(i) Full name and nationality at birth of: (**Please indicate even if deceased)
i. Father Nationality
ii. Mother (maiden name) Nationality
iii. Husband or wife (maiden name) Nationality
(j) Number of children  
(Sons) Name Date of Birth (Daughters) Name Date of Birth
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
 
2. EDUCATION

(a) Where attended

Dates

Technical/Secondary School / College / University

 From To

(b) Qualifications (degrees, certificates, diplomas, with classes, distinctions, etc.) and membership/fellowship of Professional bodies, giving the dates on which each was obtained.

(i) Academic Qualification Class (Where applicable) Date Obtained Where Obtained
       
(ii) Membership/Fellowship of Professional Bodies    
Professional Body Date obtained    
   
   
   
   
   
   
3. TEACHING/RESEARCH/PROFESSIONAL/INDUSTRIAL EXPERIENCE
(a) Present Employment
From (Date) Name and Address of Employer

 State (A) Position held
        *(B) Subjects taught/Particulars of work
         (C) Salary
(A)
 (B)
(C)
 
(b) Previous Employment
Dates Name and Address of Employer

 State (A) Position held
        *(B) Subjects taught/Particulars of work
         (C) Salary
         (D) Reasons for leaving
From To
(A)
 (B)
(C)
(D)
(A)
 (B)
(C)
 (D)

*(c) State further Details of Teaching/Research/Professional/ Industrial Experience
  

 
4. PUBLICATIONS/EXHIBITIONS (With Dates)

   

 
5. GENERAL

(a) Have you ever lived in a tropical climate? If so , state when and where.   

    

(b) If engaged, how soon after notification of selection could you leave for Ghana or assume duty.
 
6. The space below may be used for any additional information you wish to give 
        
 
7. NAMES AND ADDRESSES OF THREE REFEREES
 (At least two of them should be able to report on your Academic/Professional competence. Names of relatives must not be given).
   i.  
   ii. 
   iii.
 
8. I certify on my honour that all the information given on this form is correct. I understand that concealment of any facts or declaration of any intentional false statement(s) will be considered sufficient grounds for non-employment or for subsequent dismissal.
NOTE: CANDIDATE WOULD BE REQUIRED TO SIGN THE DOCUMENTS DURING THE INTERVIEW