HRO/F/040

Application Form for Academic Position

NOTES
1.

(
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The data in relation to your application will be used by the University of Macau to assess your suitability for assuming the position for which you are
applying, and to determine the benefits package (if applicable). It may be provided to faculties/centers, and/or any internal/external assessors
authorized to process the information for purposes relating to appointment.

2.
The ID No. collected from the applicants will be used by the University of Macau for the purpose of identity verification.
3.

Completion of all items on the form is obligatory. Failure to provide the data may affect the processing and outcome of your application. This form
should be filled in on the computer, typed or written in block letters.

4.

Please attach a current CV in English. You may also attach any other documents you consider relevant. The copies will not be returned and will be
verified in due course.

5.

It is our policy to retain the personal data of unsuccessful applicants for future reference purpose for a period of not more than two years. Thereafter,
your application together with all materials you have provided will be removed from our files.

6.

/()
You may request access to, and/or correction of your personal data by writing to the Human Resources Office of the University of Macau after
submission of this application. Please quote the reference number of the vacancy.

7.

All information given in the form will be kept strictly confidential.

Position Applied For: Professor

Reference No.: FHS/AR/10/2014

/ Faculty/Centre: Faculty of Health Sciences

I) PERSONAL PARTICULARS
Title: Prof.

(*) Dr. Mr. Ms.

Surname: Axibal

Given Name(s) in Full: Maximo, Jr.

()Chinese Name (if applicable): N/A
Country of Permanent Residence: 1- C Sulatan St., Mandaluyong City, Philippines
Nationality: Filipino

Date of Birth: 01 /08 / 1958 (dd/mm/yyyy)

ID No: Philippines EB3193245

Type of ID: Passport

Home Address: 1- C Sulatan St., Mandaluyong City, Philippines

Postal Address ( If different from Home Address above): Same as above
Residential Telephone No.:

011 63 25336733

Business Contact Telephone No.: None

Fax No.: None

Mobile Telephone No.:

63917- 8400- 261

E-mail Address(es): axibalmdpath@yahoo.com.ph

II) LANGUAGE(S) USED

Written* Spoken*

*E= Excellent; G= Good; A= Average; P= Poor

First Language

Tagalog (Pilipino)

Other Language(s)

English

III) EDUCATION AND ACADEMIC QUALIFICATIONS

( Please list in chronological order, starting with your most recent.)

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Name & Location and Country of

Field of Study

Qualifications Obtained

Year of Award

Institution

IV) / SELECTED RESEARCH WORK/PUBLICATIONS

( Please list no more than 5 items)

Title of Publication/Journal Article

Date & Place of Publication

Publisher/Journal Name

None

V) WORK EXPERIENCE
( If the space is insufficient, please use separate sheets for details or
explanations. Please also list in chronological order, starting with your most recent.)

(/)

Dates (mm/yyyy)

Name & Location of Organization/Employer

Position Held & Nature of Work

From

To
2

VI) ADDITIONAL INFORMATION

( Please write here any further information that you think might be helpful to your application.)

VII) REFERENCES
(
At least one of the references should include comments upon the applicants teaching ability or potential as a teacher.)

1.

Name: Dr. Remedios A. Magkasi, MD, FPSP, MHPEd

Position: Professor III Department of Pathology (Former Chairman)
Organization: Far Eastern University Dr. Nicanor Reyes Medical Foundation
Address: Quezon City, Philippines

CP# 63 923 311 7640;

Residence: 011 63 447207895

Telephone No.:

Fax No.: None

E-mail Address:
2.

Name: Ms. Milba M. Rutaquio

Position:

General Manager
3

 Organization:

ACTS Review Center

Address: Rm. 509 J &T Building 3894

Ramon Magsaysay Blvd
Sta Mesa, Manila, Philippines 1016
Telephone No.: CP#: 63 920 901 8844;

Fax No.: None

Office: 011 63 27167683

E-mail Address: info@actsreviewcenter.com

VIII) DATE WHEN APPLICANT CAN ASSUME DUTY: ____/____/____(dd/mm/yyyy)

IX) CRIMINAL CONVICTION

(* Please delete as inappropriate)

* /
I have not been convicted of any criminal charge in Macao or outside Macao.

X) DECLARATION
VII

I declare that the information given above is correct. I understand that if I give any false information and I am subsequently appointed to a post in the
University of Macau, I shall render myself liable to dismissal. I hereby give my consent to the University to contact my referees as provided in Section
VII above and request their comments on my suitability for the post for which I have applied.

Signature: ______________________________

Date: ____ /____ /_____(dd/mm/yyyy)

Revised on 22/02/2012