专业技术职务申请表

1、专业技术职务申请表（青年杰出人才申请正高级专业技术职务评聘专用）Application Form for Position of Professor or Equivalent Position, SYSU Outstanding Young Faculty Use Only 编号No.:申请职位Position to Apply应聘学院（系）School/ Department to Apply申请学科Academic Fieldto Apply、个人资料 Personal Information姓名Applicant Name性别Gender出生年月Date of Birth国籍Natio

2、nality最高学历、学位Highest Degree毕业院校Degree Institution毕业时间Graduation Year现聘单位Current Employer现聘职位Current Academic Title任职年月Starting from （M/Y）从事专业Field of Expertise研究方向Research Interests身份证号码ID No.电子邮件Email通讯地址MailingAddress手机Mobile No.二、学习经历（大学及以上，含海外进修经历）Educational Background（Bachelor degree and above

3、, overseas study in eluded）起止年月Date学校名称Schools/Institutions Attended（海外高校请注明所在国家）（Country Should be Stated）学历/学位Degree Obtained专业Major自 From至To、工作经历 Employment History起止年月 Date工作单位 /机构 Schools/ Institutions of Employment职务 Position Held自 From至To四、学术荣誉及社会兼职 Academic Honors & Social Services荣誉/社会兼

4、职Title of Honors/ Services获得/受聘日期Date Obtained颁授/兼职机构Issued/Employed By五、教学工作 (任现职近五年内)(可另附页) Teaching Experiencemost rece nt 5 years; ifcurrent position is shorter than 5 years, please list the experiences since the position started; if n eeded, attach a sheet.)1课程教学情况(学年学期至学年学期)Courses TaughtFrom

5、the (1 st/2nd )Semester(Year) to(1 st/2nd ) Semester(Year)类别Type开课 学年 学期Semester and Year教学课程 名称Course Title课程属性Course Type (Compulsory/Selective)学 分Credit学 时CreditHour授课对象及 人数Targeted Student and Number of Enrollment实际担任 课堂教学 学时数Actual Credit Hour for Classroom Teaching课程 系数CourseCoefficient工作 量Amo

6、untofTeachingLoadTeachingFull-timie Undergraduates总计学时数Total Credit HoursTeaching Graduates总计学时数Total Credit Hours2.指导学生情况 Students Supervised学生类别Stude nt Type时间Period（年月一年月）学生数(专业、年级、姓名)Student List (major, year in program, name)折合学时数Equivalent Credit HoursPh.D CandidatesMaster Degree Candidates指导普

7、普业全论日文制本科生毕 TheSisfl亦nergrad職es1其他Others总计学时数 Total Credit Hours3.审核意见 Verification(1)对校本部申请者的审核意见Verification for Applicants from the Main Campuses承担普通全日制本科教学工作量合计学时，年平 均教学工作量学时。其中，课程教学共学时，指 导毕业论文工作量学时，本科生教育教学其他工 作折合工作量学时。For Full-time Undergraduate Teaching :Total Credit Hours:Average Annual Credi

8、t Hours:Course Teach ing Hours:Thesis Supervisi on Hours:Other Equivale nt Credit Hours: 院系审核人签字Reviewed by :年月曰Y/M/D本科教学主管部门审核意见： Verification by the Departme nt in Charge ofUn dergraduateTeach ing:经核实，普通全日制本科生课程教学工作量 学时。For Full-time Undergraduate Teaching : Total Credit Hours:审核人签字 Reviewed by :单

9、位(公章)Official Seal :年月曰Y/M/D承担研究生教学工作量合计学时，年平均教学工 作量学时。其中，研究生课程教学共 学时，指导研究生折合学时。For Graduate Teach ing:Total Credit Hours:Average Annual Credit Hours:Course Teach ing Hours:Thesis Supervisi on Hours:院系审核人签字 Reviewed by :年月曰Y/M/D研究生教学主管部门审核意见Verification bythe Departme nt in Charge ofGraduateTeach in

10、g:经核实，研究生课程教学工作量学时，指导博 士研究生名、硕士研究生 名。For Graduate Teach ing：Course Teach ing Hours:Total nu mber of supervised Ph.D can didates :Total number of supervised Master Degree can didates :.审核人签字 Reviewed by : 单位(公章)Official Seal : 年月曰Y/M/D(2) 对附属医院申请者的审核意见Verification for Applicants from the Affiliated H

11、ospital经核实，教学工作量分，教学质量评价分，教学总分分。By verification, the score for teaching load is , the score for teaching quality is , the total score is .教学管理部门审核人签字Reviewed by(from the Departme nt in Charge of Teachi ng):单位(公章)Official Seal :年月日Y/M(3)本科教学主管部门审核意见Verificati on by the Departme nt in Charge of Un der

12、graduate Teach ing经核实，在入校工作以来有/无教学工作违纪记录。如有，请写明时间及处理结果：By verificati on, Dr.(NAME) has n'any/ has some record(s) of violati ng teach ing discipli ne since he/shebega n to work at SYSU; if has, please list the date and results below:审核人签字 Reviewed by :单位(公章)Official Seal :年月日Y/M六、研究工作 (近五年内)(可另附页

13、) Research (most recent 5 years; if needed, attach a sheet.)1.申请人学术陈述Research Statement(请陈述个人学术发展目标、5年学术计划、当前工作中可望取得突破的课题，以及三者之间的关联性)(State the applicant 'aims of academic development, plans for the next fiveyears, difficultresearch problems may be solved and the relation among the above three a

14、spects.)2.代表性论著 Representative Publications序号#按全部作者排序(注明学生、通讯作者、共同第一作者、共同 通讯作者)、论文题目、刊物名称、出版日期、卷号、期号、 起止页码列出List of Author(s) (please indicate whether the publication is co-authored with your supervised students, whether you are the correspondence-author,or whether authors share equal authorship), A

15、rticle Title , Journal Title, Year of Publication, Volume #, Issue #, Pages刊物类别Jour nal Category收录、引 用或转 载 情况No. ofCitati ons12345678910序 号#著作/教材名称Title of PublishedBook(s)全部作者排序List of Author(s)出版单位Published by出版时间Year ofPublicati on著作 总字数Total WordCou nt本人撰 写字数Perce ntage ofPers onalCon tributi on

16、12345统计Tote文科填写 Humanities and Social Sciences rr 1-1 1t » 1t I. . f. 、 SSCI、SCI影响因 子前1%刊物论文(第一或通讯作者，作者 单位为中山大学)SSCI, SCI journals with top 1% IF ( first-author or correspondence-author paper，author 'work institution should beSYSU)国际顶尖A类学 术期刊论文(第一 或通讯作者)International top-A academic journals

17、 (first-author or correspondence-author paper)所属一级; 公认的权 讯作者)journals ir inter-discip or corre总数Total学科(及交叉学科) 威期刊论文(第一或通Public-recognizedauthority 1 the first-level discipline or ines of the field ( first-author spondence-author pape)作者单位为中山大学 论文 author'work institution is SYSU者件/教材：获得教育部咼 等学校科

18、学研究优秀成果 (人文社会科学类)二等 奖或以上奖励(第一作者， 作者单位为中山大学)Books: Second Prize or higher of Excellent AchievementsAward for Scientific Research in Higher Educational Institutions by the Ministry of Education, China (for Humanities and Social Sciences) (first-author, author's work in stituti on should be SYSU)l理

19、工医科填写 Science and Engineering， Medical ScienceScience Nature、Cell 等学术刊物及其高影 响因子的子刊论文 (第一或通讯作者)Science, Nature, Cell and their sub-journals with high IF (first-author or corresp onden ce-author paper)本专业领域权威 期刊论文(通讯作 者)Authority journals in the field (correspondence-author paper)所属一级学科(及交叉学科) 的权威期刊(即

20、影响因子最高 的1-3种期刊)论文(第一或通 讯作者)Authority journals (one to three kinds of journal with highest IF ) in the first-level discipline or inter-disciplines of the field(first-author orcorresp onden ce-author pape)收录为 ESI的Top Paper 论文(第一或通讯作者) Selected as Top Paper of ESI (first-author or correspondence-author

21、 pape)总数 Total通讯作者且作者单 位为中山大学论文correspondence-author and author's work institution is SYSU总数 Total通讯作者且作者单位 为中山大学论文correspondence-author and author'work institution is SYSU所在单位审核人签名Reviewed by (from the Department/ School):单位(公章) Official Seal :年月日 Y/M/D科研部门审核人签名Reviewed by (from the Departm

22、e nt in Charge of Research Adm ini strati on):单位(公章) Official Seal :年月日 Y/M/D3.承担科研项目(不含校内项目)Research Grants (university-level grants not included)序号#按项目来源及类型、项目名称、项目批准号、项目全部参加人员(注明主持 人)、起止时间(注明计划完成时间、实际完成时间)、本人承担部分列出Source of Funding, Title of the Grant/Project(No.),List of Project Members(project

23、director should be in dicated clearly), Begi nning & Ending Dates(pla nned ending date and actual ending date should be in dicated), Porti ons Resp on sible.经费 总数Grant(RMB)到帐 经费Amo unt Receive d(RMB)123统 计国家级National Level Grant(s)部省级Min istry/Provi ncial Level Gran t(s)厅局级Departme nt/Bureau Lev

24、el Gran t(s)其他Other Gran t(s)主持Project Director参加(前二)Participa nt (Top Three)主持Project Director参加(前二)Participa nt (Top Three)主持Project Director参加(前二)Participa nt (Top Three)Total10院系审核意见 Verification bytheDepartment/ School :审核人签字 Reviewed by :单位（公章）Official Seal :科研主管部门审核意见Verification by the Unive

25、rsity ResearchAdministration Department :已对申请人在本栏目填写的项内容，包括项目来源及类型、目名称、经费、参加者排序、申请时间及结项时间、统计等信 息进行审核。Information of the itemsin the above table has been verified, including the source, type, title, amount(RMB), order of participants, beginning & ending dates and total number of gran ts/projects.

26、年月曰 Y/M/D审核人签字Reviewed by :单位（公章） Official Seal :年月日Y/M/D七、其他与申请本职位有关的情况Other lnformation(in relation to this applicatio n)(如社会服务情况、其他奖励等，可另附页)(State social and community services, administrative and school services, other awards, etc. Please attach separate sheet, if necessary)八、声明本人谨此声明以上所有资料及所附证明

27、文件均属真实、符合学术道德规范，并可提供有关身份及资历文件的正本以供核实。本人明白倘若故意虚报资料或隐瞒重要事实，中山大学可取消已发出的口头或书面聘约，即使已获聘任亦可被解聘。I hereby declare that the in formati on give n above is true, correct, complete and in accorda nee with the academic moral rule. Evide nee about my ide ntity and qualificati ons can be providedfor verificati on i

28、f necessary. I understand that any falsification or failure to state the truth will result in cancellation of appo in tme nt eve n if an oral /writte n offer has bee n made, or even if the appo in tme nt has begu n.签名：Sig nature:日期：Date (Y/M/D):填表说明Notes1请用中英文填写， 表格内如无内容填写时要写 “无”。填妥后请用A4纸双面打印(填表说明无需

29、打印)。Please fill in the form in both Chinese and English. Please fill out NONE when there is not any appropriate information to be filled in.Please print the form (excluding this page) in A4 paper on both sides.2若填写内容较多，可插入行、调整字体大小、表格内部宽度，但不得改变页面内容格式和表格其他结构。若 加附页，请严格依照本表格式与大小，页码标为附X-1、附X-2等(如第五项教学工作，

30、增加附页，页码标为附五-1、附五-2 等)。Please adjust the font size and width of the table or add columns to the table if there is not enough space. However, the content and format of each page should not be changed. The format of attachments should be in accordance with the relevant part of the main form and should

31、be labeled as ATTACHMENT-X-1 (for example, if there is attachment to the fifth part: Teaching Experience, the attachment should be labeled as ATTACHMENT-V-1, ATTACHMENT-V-2, etc.)3申请学科：填至二级学科；从事专业：填写专业名称；通讯地址：填写可以通过邮政方式接收信件的实际地址，建议填写家庭地址。In the first part of the form: Academic Field to Applyshould s

32、pecify the sub-disciplinesField of Expertise should specify the name of subject;MailingAddress is supposed to be your home address.4. 第二项学习简历：请从大学开始，按自然时间顺序填写，分大学本科、硕士、博士等阶段；第三项工作经历按不同工作单位/机构任不同职务经历的顺序填写；博士后阶段按工作经历填写。Educational Background: bachelordegree and above should be stated in time sequence.

33、Employment History: all employers worked for and positions held should be stated in chronological order. Postdoctoral experience should be stated in this part.5. 第五项教学工作：课程属性指公必课(理论 /实验)、公选课(核心通识/非核心通识)、专必课(理论/实验)、专 选课(理论 <核心/非核心 >/实验)、实习 /见习等。Teaching Experience Course Typerefers to Compulsor

34、y Courses (theoretical/experimental), Public Selective Courses (core liberal/ non-core liberal), Major Required Courses (theoretical/experimental), Major Selective Courses (theoretical (core/non-core)/experimental) and Intern, etc.6. 代表性论著请按相应要求填写，作者中有本人指导的学生时，请在学生名字处注明；刊物类别，文科按SSCI、SCI影响因子前1%的刊物、国际

35、顶尖 A类学术期刊、在所属一级学科(及交叉学科)公认的权威期刊填写，理工医科按、Science Nature、Cell等学术刊物或其高影响因子的子刊、在所属一级学科(及交叉学科)的权威期刊(即影响因子最高的 1-3 种期刊)、ESI 的 Top Paper 填写。Representative Publications Please fill in the table according to the requirements. Please indicate the student you supervised if he/she is one of the authors. Journal

36、Category: Applicants from Humanities &Social Sciences should indicate SSCI, SCI journals with top 1% IF (Influence Factor), i nternational top-A academic journals,public-recognizedauthority journals in the first-level discipline or inter-disciplines of the field; Applicants from Science and Engineering， Medical Science should indcate Science, Nature, Cell and their sub-journals with high IF,authority journals (one to three kinds of journal with highest IF ) ,Top Pape