THE CHINESE UNIVERSITY OF HONG KONG

Faculty of Medicine

RECOMMENDATION FOR HONORARY/ADJUNCT TEACHING APPOINTMENT

NEW NOMINATION (FORM B)

The information provided will be used for appointment and other employment-related purposes in the University. It may be accessible to offices, committees or persons who will process appointment matters.

Part I. TO BE COMPLETED BY NOMINEE

1. Personal Particulars

Name in English / Title: Prof./Dr./Mr./Mrs./Miss/Ms
Name in Chinese / HKID Card No.
Residential Address
Home Telephone

2. Present Main Employment

Employing Institution
Position Held
Business Address
E-mail / Office Telephone / Office Facsimile

3. Academic and Professional Qualifications

Name of Degree/Qualification / Awarding Institution / Year

I understand that the above information will be used to support the honorary/adjunct appointment for which I agree to provide service to the University. I enclose herewith a copy each of my Hong Kong identity card (and passport with particulars on employment visa showing initial entry date to Hong Kong, if applicable) Note and academic/professional credentials.

Signature: / Date:

(Note The nominee may choose to present the original of his/her Hong Kong identity card/passport in person to the Personnel Office in lieu of providing a photocopy alongside this nomination form.)

Part II. TO BE COMPLETED BY NOMINATING DEPARTMENT

1. Duties Recommended (Please place an ‘X’ in all appropriate boxes)

Lecture /
Teaching Rounds
/ Tutorial/Seminar / Outpatient Clinic / Research

The nominee will/will not * teach a course or part of a course in the regular academic curriculum

2. Recommended Title (Please place an ‘X’ in all appropriate boxes)

Adjunct Professor / Adjunct Associate Professor
Clinical Professor (honorary) / Clinical Associate Professor (honorary)
Adjunct Assistant Professor / Adjunct Tutor (unpaid)
Clinical Assistant Professor (honorary) / Clinical Tutor (honorary) (unpaid)

3. Appointment Recommended (Please place an ‘X’ in all appropriate boxes)

paid on monthly basis / paid on sessional basis # / unpaid / Funding source@:
4. /
Recommended Period of Appointment
/ From / To

(In view of legal requirements, recommendation for retroactive appointment will NOT be accommodated.)

Recommended by: / Signature:
Department: / Date:

* please delete the inappropriate # should not exceed 10 sessions per year @ to be completed for honorarium recommended for private practitioners only