APPLICATION FORM - The Institute for European Studies

APPLICATION FORM
The completed form should be returned to:
The Academic Director of the IES
Vrije Universiteit Brussel
Pleinlaan 2
1050 Brussel
TO BE COMPLETED BY THE CANDIDATE
Family and given names (in block letters; married women should give their maiden name):
...............................................................................................................................................................
Date of birth: .........................................................................................................................................
Reference number of the vacancy + name of the faculty where the position is to be taken up:
...............................................................................................................................................................
Name of the course(s) or the position being applied for:
...............................................................................................................................................................
...............................................................................................................................................................
Degree(s) (including name of the university date and grade):
...............................................................................................................................................................
...............................................................................................................................................................
Present position:
...............................................................................................................................................................
...............................................................................................................................................................
Date and signature:
IMPORTANT
If you are not already employed at the VUB, then this application must include the following pages 2-9, together with a
certificate of military service (where relevant), a certified copy of degree certificate(s), a completed form declaring any
supplementary employment and proof of previous employment relevant to academic seniority or to establishing seniority
in the salary scale.
Any originals should be appended to the application form addressed to the rector; copies may be appended to the
application form intended for the faculty.
The VUB guarantees that applications are dealt with according to the terms of the data protection law of 8 Dec. 1992.
The information you provide will be used only for the present application. Where the application is successful, the same
information will be used for transactions arising from the terms of the employment contract.
Job application form
1
SUPPLEMENT TO THE APPLICATION FORM TO BE COMPLETED BY APPLICANTS NOT
ALREADY EMPLOYED BY THE VUB OR THOSE APPLYING TO A DIFFERENT FACULTY
Please affix
recent
passport
photograph
I. GENERAL INFORMATION (in block letters please)
Family name (Married women should give maiden name) ..................................................................
Given name(s) .......................................................................................................................................
Sex: Male/Female
Date of birth .................................................Place of birth ..................................................................
National registry number (Belgium) . . . . . . - . . . . . . Nationality .........................................
Street ..........................................................................House number ............ Postbox number .........
City ............................................................................Postal code .......................................................
Telephone .............................................................................................................................................
Address for correspondence (if different from above)
Street ..........................................................................House number ............ Postbox number .........
City ............................................................................Postal code .......................................................
Current bank account number ...............................................................................................................
Name of bank ........................................................................................................................................
Marital status: single / married / widowed / divorced / legally separated / separated de facto
Physical handicap
Widow(er) not remarried
Unmarried parent with child dependant
yes / no
yes / no
yes / no
Spouse
Family name (married woman's maiden name) ....................................................................................
Given name(s) .......................................................................................................................................
Date of birth ..................................................... Place of birth .............................................................
Occupation ....................................................... Nationality .................................................................
Does your spouse have a recognised handicap?
yes / no
1
Does your spouse have an earned income?
yes / no
Spouse's occupational category:
manual worker / servant / clerical worker / self-employed / miner / merchant marine /
established civil servant / other: ............................................................................................................
1
Including any income, such as benefits or pensions, accruing as a result of employment.
Job application form
2
Dependants
1. Child dependants
Family name
Given name(s)
Date of birth
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
...................................................
..............................................
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...................................................
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.........................................
...................................................
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.........................................
1.1 Child dependants with a recognised handicap
Family name
Given name(s)
Date of birth
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
2. Adult dependants
Family name
Given name(s)
Date of birth
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
2.1 Adult dependants with a recognised handicap
Family name
Given name(s)
Date of birth
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
...................................................
..............................................
.........................................
Do you receive child benefit? .............................................................................................................
Military service fulfilled from ...................................to ....................................................................
Yet to be fulfilled from ..............................................to ....................................................................
Exempt from military service because of ...........................................................................................
The applicant hereby declares:
• that any changes in personal or family circumstances will be declared to the personnel department as
soon as possible, and
• that the information given above is correct.
Place + date + signature:
Job application form
3
II. EDUCATIONAL QUALIFICATIONS
Secondary education (school(s), specialisation, dates and qualifications):
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Higher (incl. university) education (institution, specialisation, dates and qualification incl. grade):
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Title of thesis submitted for degree (where applicable):
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Postgraduate qualifications other than doctorate:
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Doctorate (incl. title of thesis):
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Postdoctoral qualification (Aggrégation E.S. – Aggregatie H.O.), incl. title of thesis:
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Any other qualifications
...............................................................................................................................................................
...............................................................................................................................................................
Job application form
4
III. PROFESSIONAL EXPERIENCE
A. Not at the Vrije Universiteit Brussel: type of experience, where and when gained.
• currently
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
•
previously
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
B. At the Vrije Universiteit Brussel
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
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C. Other university experience, administrative or organisational responsibilities
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
D. Any other relevant experience (may be detailed in an addendum)
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Job application form
5
DECLARATION
I, the undersigned, .......................................................................................................... ,
declare formally that I am a supporter of the principle of free enquiry, viz. a disinterested
search for truth on the basis of scientific method, implying a rejection of any form of
authority principle with regard to intellectual, philosophical or moral concerns, as well as
the rejection of any form of revealed truth.
I declare that I shall behave in conformity with the above conviction.
Date
Job application form
Signature
6
DECLARATION OF EXTRACURRICULAR ACTIVITIES
(DECLARATION OF EXTERNAL WORK)
Academic year …………………
I. Personal details
Family and given names : .....................................................................................................................
Staff status : ...........................................................................................................................................
VUB Faculty (or interfaculty dep't) : ....................................................................................................
University hospital function (where applicable) ...................................................................................
II. Members of the academic staff employed full-time
1. Other professional activities or other paid activities


I have no other professional or paid activities
I hereby apply for permission to carry out another professional or paid activity.
Name & address of the institution, organisation or place where the activity is carried out:
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Description of the type of activity / activities:
....................................................................................................................................................
....................................................................................................................................................
Employment status (liberal profession, self-employed, salaried, education)
....................................................................................................................................................
Scope (hours per week expressed as annual average per week or, for educational activities,
level, number of hours taught, fraction of a full-time position)
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Please turn the page
Job application form
7
2. Other unpaid activities


I have no other unpaid activities
I carry out the following unpaid activities
Description:
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Scope (hours per week expressed as annual average per week):
....................................................................................................................................................
....................................................................................................................................................
3. Specific functions under the Decision of the Flemish Government of 5 May 1993
I have the following function(s):
a)

Member of the European Parliament

Member of the Belgian Parliament

Member of the Flemish or other state legislature

Member of the Commission of the European Communities

Governor, vice-governor, permanent deputy, mayor, member of the municipal executive
or chair of the public welfare committee of a municipality of more than 50,000 inhabitants
Please specify:
........................................................................................................................................
b)

Exercising a liberal profession or other self-employed occupation
Which? ..........................................................................................................................
Are you a trainee in this profession? .............................................................................
Are you an appointed executive of a civil or commercial enterprise? ...........................
c)

Do you hold a teaching appointment in another university of other institute of higher
education in Belgium or abroad comprising more than two hours' teaching per week?
Scope of the appointment (level, number of hours taught, fraction of a full-time position):
........................................................................................................................................
........................................................................................................................................
Name and address of the institution:
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
Please turn the page
Job application form
8
III. Members of the academic staff employed part-time
1. Other professional activities or other paid activities


I have no other professional or paid activities
I have the following professional function or activity.
Name & address of the institution, organisation or place where the activity is carried out:
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Description of the type of activity / activities:
....................................................................................................................................................
....................................................................................................................................................
Employment status (liberal profession, self-employed, salaried, education)
....................................................................................................................................................
Scope (in half-days per week or, for educational activities, level, number of hours taught,
fraction of a full-time position)
....................................................................................................................................................
2. Other unpaid activities


I have no other unpaid activities
I carry out the following unpaid activities
Description:
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Scope (hours per week expressed as annual average per week):
....................................................................................................................................................
....................................................................................................................................................
I hereby declare that the above declaration with regard to other professional or paid activities and to
other unpaid activities is correct and complete.
I declare that I am prepared
(a) to request prior permission from the governing body of the University for any supplementary
professional or other paid activity
(b) to notify the Rector immediately of any changes with regard to unpaid activity.
I certify the accuracy of the above declaration,
Date + signature
Job application form
9