APPLICATION FORM  FOR FACILITATOR'S POST
  
 
OPEN UNIVERSITY MALAYSIA
  
 
Date: 14:23 PM 03 Nov 2025
  
 
 
 
 
 
 
     
  * compulsory fields  
 
 
Program
*University Learning Centre
*Faculty Center Of Post Graduate Studies
 
Select courses you wish to teach
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
 
     
  A. PERSONAL PROFILE  
     
 
Designation
*Full Name
*Correspondence Address
 
*Postcode *City
*State
 
     
  Telephone Number  
 
House Office
*Mobile Facsimile
*Email
 
     
 
IC Number
*New (without dashes) Old
Date of Birth
*Race  
*Sex MALE         FEMALE
*Marital Status
Passport *For Non Malaysian Citizen
Passport No. Passport Expiry Date
Visa Expiry Date Permit Expiry Date
Languages
Bahasa Malaysia Spoken
Written
English Spoken
Written
Others (please specify) Spoken
Written
 
 
   
Current Job (eg: Manager in IT Department)
Office Address
 
Postcode City
 
     
  * B. EDUCATIONAL BACKGROUND  
  **Only those who have received their certificate of completion from university can fill in the column.  
 
  Level of Education Specialization University / Institution

**Year of
Graduation
1
2
3
4
 
     
  C. Teaching Experience (or any other Training session conducted)  
  ** Year only (eg :2004)  
 
  Institution Subject

**Year From

**Year To

 Level Taught (eg:Cert/Dip/Deg)
1
2
3
 
     
  D. Working Experience  
 
  Organisation Position

**Year
From

**Year
To

1
2
3
 
     
  * E. List of 5 most important Publications or Research during the last 5 years (if any)  
 
Publication/
Research (1)
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Publications/
Research (2)
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Publications/
Research (3)
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Publications/
Research (4)
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Publications/
Research (5)
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  F.Computer and Internet Skills  
 
Computer Skills  
Microsoft Word
Microsoft Power Point
Microsoft Excel
   
Internet Skills  
Email
Downloading
Online Moderation
 
     
     
  G. Interests  
 
Interests (eg: reading, tennis, swimming, cooking)
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  H.Bank Account No. (if applicable)  
  Bank  
  Account No  
     
     
 

What can you contribute to OUM ? (Please indicate in not more than 500 words.)


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* compulsory fields
** Year only (eg :2004)