2. Name: _____________________________________________________________
Title: ____________________
Company: _________________________
Contact Phone: _______________
Mobile: ___________________________
Email: _______________________________________________________________
3. Name: _____________________________________________________________
Title: ____________________
Company: _________________________
Contact Phone: _______________
Mobile: ___________________________
Email: _______________________________________________________________
Do you wish your application to be considered for appointment with professorial title?
Yes □
No □
(Please note - this is for academic positions only)
DIVERSITY DETAILS
Gender (optional):____________________
Yes □
No □
Are you an Australian/New Zealand citizen?
If not, do you have a valid Australian work permit? Yes □
No □
Country of Citizenship: ____________________
Visa Class: ____________
Visa Number: ___________________________
Expiry Date: ___________
Do you have any specific requirements for the selection process? Yes □ No □
If yes, please specify____________________________________________________
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