Candidate No.
 
  (for official use only)

Application for Employment as Native-speaking English Teacher
under the Enhanced Native-speaking English Teacher (NET) Scheme

* Please delete as appropriate

(A) Personal Particulars

Name: * Mr/Mrs/Ms __________________________________________
              First name                                                                         Family name

Date of Birth: ____ / ____ / ____ Place of Birth _____________ Nationality _____________
  D   /   M   /   Y    

*Passport/Hong Kong Identity Card Number ____________________________

Residential Address _____________________________________________
_____________________________________________
_________________
(Country)

Correspondence Address
(if different from the address given above)
_____________________________________________
_____________________________________________
_________________
(Country)

Telephone Number (with country code) Residence_____________________Office____________________

Fax Number ___________________________ E-mail address ______________________________
(B) Academic attainment (in chronological order)
Colleges, universities, etc. attended Qualifications
e.g. BA , MEd
Major Subjects Full or part time on campus / distance learning Date (month / year)
          From To
          / /
          / /
          / /
          / /
          / /
(Please put your name and mailing address in the boxes below to facilitate correspondence with you)

Name ______________________
Address ______________________
  ______________________
  ______________________
  ______________________
Name ______________________
Address ______________________
  ______________________
  ______________________
  ______________________
(C) Teacher training qualifications (in chronological order)
Qualifications Full name of issuing authority Full or part time on campus / distance learning Date (month / year)
        From To
        / /
        / /
        / /
        / /
        / /
(D) Teaching experience (in chronological order)
Please state only continuous employment of more than 3 months
Name of institution Levels taught Subjects taught Date
(day/month/year)
Full or part time
      From To  
      /     / /     /  
      /     / /     /  
      /     / /     /  
      /     / /     /  
      /     / /     /  
(E) Skills
(a) Language
First Language Second Language Others
     

(b) Others (extra-curricular activities, etc.) ___________________________________ _______________________________________________________________________
(F) Other Information
(a)  Have you ever been found guilty of an offence in a court of law whether or not in Hong Kong? Yes / No*
If yes, please give details ___________________________________________________________
(b)  Do you have any previous record(s) of disciplinary offence whilst in employment with a school whether or not in Hong Kong? Yes / No*
If yes, please give details ____________________________________________________________

(Note: A criminal conviction or a record of disciplinary offence is not necessarily a barrier to employment)
(G)   (a) I understand that if I wilfully give any false information in this application form or withhold any material information, I shall render myself liable to dismissal and any other disciplinary action if appointed in a school in Hong Kong.

(b) I understand and accept that the information given above will be provided to departments/agencies authorised to process the information for purposes relating to appointment under the Native-speaking English Teacher Scheme, e.g. qualifications assessment, employer reference and integrity checking, etc. as may be necessary.

Signature of Applicant _____________________ Date _____________________