Penerimaan Guru di Balai Bahasa Indonesia Australia
Balai Bahasa Indonesia Perth (Inc) in collaboration with the Consulate General
of the Republic of Indonesia Western Australia, and Department of Education
Western Australia
APPLICATION FORM
Indonesian Language Assist ant Program of West ern Aust ralia
January - December 2018
Bef ore f illing in t his int eract ive f orm, make sure you have read t he LAP Guidelines 2018.
These can be f ound at www. balaibahasapert h. org/ language-assist ant -program or
ht t p: / / kj ri-pert h. org. au
Follow all direct ions in t he LAP Guidelines 2018 when complet ing and submit t ing your
applicat ion via email.
Each sect ion of t his applicat ion f orm must be complet ed.
Type in t he spaces provided, save a copy and email t oget her wit h t he support ing
document s list ed in t he Guidelines t o lap@balaibahasapert h. org .
Please make absolut ely sure t hat your cont act det ails will be current unt il t he end of year
2017.
1
I.
PERSONAL DETAILS
a. Name:
b. Email:
c. NIP/ No. Reg:
d. Place/ Dat e of Birt h:
e. Male/ Female:
f . Occupat ion:
g. Current Address:
Cit y:
Post Code:
h. Mobile phone:
i. Marit al St at us:
Single
Married
j . Hobbies/ Favourit e past imes:
II.
EDUCATION
Name
S-1
S-2
Name of
Universit y
Year
Facult y
Maj or
Thesis
Index
Cumulat ive
(IPK)
2
S-3
III.
EMPLOYMENT DETAILS
Year
Position
Employer
2017
2016
2015
IV.
No
1
LANGUAGE
Language level
English
Good
Fair
Element ary
2
V.
No
IELTS
Score:
Dat e:
TOEFL
Score:
Dat e:
Ot her Languages:
Professional development (Seminars/ Courses/ Training)
Course
Institution
1
2
3
4
3
Place
Date
5
Use this space to add any dditional professional development that may be relevant:
VI.
Social Activities
No
Organisations
Positions
1
2
3
4
5
VII.
Persons to be notified in Indonesia in case of emergency:
Name:
Relat ionship:
Address:
Telephone:
Email:
4
Years
Use this space to add additional information you may wish the selection panel to
consider:
VIII.
Declarations
If accept ed f or t he Program, I agree t o:
Abide by t he regulat ions of t he Depart ment of Educat ion of West ern Aust ralia.
Accept t o work out side t he cit y of Pert h during t he program, as required.
Act ively promot e Indonesian language and cult ures in West ern Aust ralian Schools.
Accept responsibilit y f or my daily f inancial requirement s (e. g. accommodat ion, f ood,
clot hing, ut ilit ies and ot her necessary expenses) during t he program.
I cert if y t hat t he st at ement s I have made in response t o t he f oregoing quest ions are t rue,
complet ed and correct t o t he best my knowledge.
---------------------------------------------
----------------------------------------
Dat e
Signat ure
Applicat ions close Friday 30 June 2017
Email form to [email protected]
5
of the Republic of Indonesia Western Australia, and Department of Education
Western Australia
APPLICATION FORM
Indonesian Language Assist ant Program of West ern Aust ralia
January - December 2018
Bef ore f illing in t his int eract ive f orm, make sure you have read t he LAP Guidelines 2018.
These can be f ound at www. balaibahasapert h. org/ language-assist ant -program or
ht t p: / / kj ri-pert h. org. au
Follow all direct ions in t he LAP Guidelines 2018 when complet ing and submit t ing your
applicat ion via email.
Each sect ion of t his applicat ion f orm must be complet ed.
Type in t he spaces provided, save a copy and email t oget her wit h t he support ing
document s list ed in t he Guidelines t o lap@balaibahasapert h. org .
Please make absolut ely sure t hat your cont act det ails will be current unt il t he end of year
2017.
1
I.
PERSONAL DETAILS
a. Name:
b. Email:
c. NIP/ No. Reg:
d. Place/ Dat e of Birt h:
e. Male/ Female:
f . Occupat ion:
g. Current Address:
Cit y:
Post Code:
h. Mobile phone:
i. Marit al St at us:
Single
Married
j . Hobbies/ Favourit e past imes:
II.
EDUCATION
Name
S-1
S-2
Name of
Universit y
Year
Facult y
Maj or
Thesis
Index
Cumulat ive
(IPK)
2
S-3
III.
EMPLOYMENT DETAILS
Year
Position
Employer
2017
2016
2015
IV.
No
1
LANGUAGE
Language level
English
Good
Fair
Element ary
2
V.
No
IELTS
Score:
Dat e:
TOEFL
Score:
Dat e:
Ot her Languages:
Professional development (Seminars/ Courses/ Training)
Course
Institution
1
2
3
4
3
Place
Date
5
Use this space to add any dditional professional development that may be relevant:
VI.
Social Activities
No
Organisations
Positions
1
2
3
4
5
VII.
Persons to be notified in Indonesia in case of emergency:
Name:
Relat ionship:
Address:
Telephone:
Email:
4
Years
Use this space to add additional information you may wish the selection panel to
consider:
VIII.
Declarations
If accept ed f or t he Program, I agree t o:
Abide by t he regulat ions of t he Depart ment of Educat ion of West ern Aust ralia.
Accept t o work out side t he cit y of Pert h during t he program, as required.
Act ively promot e Indonesian language and cult ures in West ern Aust ralian Schools.
Accept responsibilit y f or my daily f inancial requirement s (e. g. accommodat ion, f ood,
clot hing, ut ilit ies and ot her necessary expenses) during t he program.
I cert if y t hat t he st at ement s I have made in response t o t he f oregoing quest ions are t rue,
complet ed and correct t o t he best my knowledge.
---------------------------------------------
----------------------------------------
Dat e
Signat ure
Applicat ions close Friday 30 June 2017
Email form to [email protected]
5