General Staff Summary Application Form	Form 6.06a
* Attach Full Résumé					   Macquarie  University 9 December 2001

Position applied for: ____________________________________  Position No.: ________________

Have you ever been employed in the University?	  No  	 Yes - Employee Number:  ____________
	Are you currently employed in another position in the University?       No           Yes	
		If yes: Division/Office:    ____________________________________________

 		 Academic           General	         Level: ___________   Fraction: ________%

Family Name: ________________________________  Title: ______    Gender:   Male     Female  
Other Names: __________________________________________        Date of Birth:  ___/___/_____
Home Address:     __________________________________________________________________
_________________________________State: ______ Post code:  ______ Phone (h):  ___________
Are you a Permanent Resident?:       Yes          No - * Attach a photocopy of visa from passport
Citizenship:   Australia        New Zealand       Other - ______________________ (please state)
Qualifications (show institution, year awarded, major subjects): _______________________________
_________________________________________________________________________________

Employment over last 10 Years (in reverse chronological order, current position first):
Employer	From (Mth/Yr)	To (Mth/Yr)	Position Held	Salary 
(per annum)	
	/	/		$	
	/	/		$	
	/	/		$	
	/	/		$	

Names, addresses and telephone numbers of three persons who have consented to act as referees:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Earliest date to take up duty:  ___/___/____

Do you contribute to one of the following:   State Super. Fund    State Public Service Super. Fund  
	 State Authorities Super. Fund   	  Super. Scheme for Australian Universities
I hereby certify that this information is true and accurate to the best of my knowledge.   
(Crucial statements found to be false within your knowledge may make you, if appointed, liable to dismissal.)

Signature of applicant:  ______________________________________          Date:    ___/___/_____