EXECUTIVE MBA APPLICATION FORM

Transcription

1 EXECUTIVE MBA APPLICATION FORM Please read the entire form carefully before filling it. The information provided by you in the application form will be of immense assistance to the Admission Committee in the evaluation of your candidature for the programme. We therefore urge you to take great care in completing this application. We have enclosed 3 forms to be completed by your referees. One out of the three reference forms should be completed by your company's managing director or your immediate boss. Please draw the attention of your referees to the contents on the reverse side of the form. FOR OFFICE USE Items included Tick Checked by Remarks Four (4) passport photos Three (3) completed reference forms Company's consent/sponsorship CV Company Organogram Degree Certificate O level Certificate (5 credits including English and Math s) NYSC Certificate (for Nigerian applicants only) PGD (Required if you have a 3 rd class or HND) Evidence of ability to pay (bank statement or pay slip for selfsponsorship) GMAT Score 1 P a g e

2 PLEASE FILL OUT THIS FORM IN BLOCK LETTERS PERSONAL DETAILS Surname First name Others What name would you like to be called in class? Sex Date of birth Nationality Marital status Spouse's name No. of children Ages Affix one photograph here (enclose three more photographs with this form). Home address Hobbies Telephone Address State of Origin Ethnic Group Religion (please tick) Islam [ ] Anglican [ ] Methodist [ ] Roman Catholic [ ] Other Christian [ ] Others indicate COMPANY DETAILS Company name Nature of business Company's turnover No. of employees Business address Telephone Fax Mailing Address (if different from above) Job title Enclose the organogram of your organization, showing your own post clearly labeled, as well as other principal managers. EDUCATIONAL BACKGROUND List below your academic history, including secondary and higher education. Institution Location Period From To Title, field and class of degree* 2 P a g e

3 List below other formal academic courses, post graduate work or management programmes (of at least three weeks duration) which you have participated in Course / Workshop title Duration Institution / Organisation Location GMAT score & year of test. (If you have not already requested for your GMAT score report to be sent to the Pan-Atlantic University, please do so). Secondary Education How many credits (WAEC, NECO or GCE) Grade in English Grade in Math s Exam sitting (once or twice) *Please attach photocopies of credentials for degrees, candidates should request for their former institutions to send originals of transcripts to the Pan-Atlantic University. WORKING EXPERIENCE List chronologically the organisations for which you have worked and your positions within them, including your present one. Also enclose your curriculum vitae. Name of Company Position held Period: MM/YY - MM/YY No. of employees List any professional bodies, associations, sports or social clubs, and voluntary organisations of which you are a member. Mention also any post you have held in each. Name of organisation Year joined Nature of organisation Position held if any 3 P a g e

4 In 150 words or less, tell us about a. Your personality: b. Any ethical dilemma you have experienced and your solution to it: c. Any significant achievement and a failure in your professional, academic and social life: 4 P a g e

5 1. Please state clearly if permission has been granted to the applicant to participate in the Executive MBA Programme. I, On behalf of Declare that the applicant is permitted to participate in the Executive MBA Programme 2. Please state clearly whether the company will/will not be responsible for the fees. I, On behalf of Declare that we shall / shall not be responsible for the full sponsorship of For the Executive MBA Programme starting from Signature of company representative & date... Applicant s signature & date 5 P a g e