Family or last name: ... First names: ...
Title: Dr / Mr / Mrs / Miss / Ms ... Preferred Name: ...
Citizenship: ...
Residential Status: ...
Postal Address: Business ...
...
Phone: ... Facsimile: ... Email: ...
Address: Private ...
...
Phone: ... Facsimile: ... Email: ...
Have you been enrolled at Massey University before? Y N
If so, please provide I.D. number: ... Or first year of enrolment: ...
Current Occupation: ...
Job Title: ... Since: ... / ... / ...
Employer: ... Since: ... / ... / ...
Location: ... Date of Birth: ... / ... / ...
Application Form
REFEREES
List the titles, names and complete addresses of two persons who know you well, in New Zealand (including past and/or present employers), from whom we can request referees’ reports.
Name: ... Name: ...
Address: ... Address: ...
...
Which MBA mode are you interested in? (Tick one box) Fast Track Executive Modular
EMPLOYMENT HISTORY
Dates: Employer Name & Address Job title and list of duties Responsible to (Title) No. of staff for whom responsible
Total years of work experience / employment ...
G r a d u a t e S c h o o l o f B u s i n e s s
PREVIOUS MANAGEMENT TRAINING
Personal Assessment of Competence
Please rate your level of competence in each of the following skills, using a scale of 0-5, and add any comments.
0 = No skill or experience 3 = Competent and experienced
1 = Acquainted but no experience 4 = Advanced competence and extensive experience
2 = Rudimentary Competence
PLEASE RETURN THIS FORM TO:
MBA Admissions Secretary MBA Programme The Graduate School of Business Massey University Private Bag 11 222 Palmerston North Phone: 0-6-350 5801 Fax: 0-6-350 5809 Email: MBA@massey.ac.nz
SKILLS RATING COMMENTS
Basic Computing Report Writing Public Speaking Negotiations
Planning Techniques Data Analysis
Interpretation of Accounts Operations Management Accountancy
NOTE: Please ensure that all sections are completed accurately, in full and legibly (please print).
THE PRIVACY ACT
Massey University Graduate School of Business undertakes to collect, use and store the information you provide on this form according to the principles of the Privacy Act 1993. The information will be used to prepare for selection interviews, class / course rolls, graduation lists, programme administrative and database records, research reports, curriculum reviews, public relations, Alumni and other associated purposes. It will also be used for reports required by the Ministry of Education and the Graduate School / University, and for administrative purposes within the same organisations. I agree that this information can be used for these purposes by the Graduate School / University.
CANDIDATE’S SIGNATURE ... DATE: ...
TERTIARY EDUCATION
(Include all major courses, awards, qualifications).
Dates: Institution Address Field of Study Award or Qualification
ADDITIONAL INFORMATION REQUIRED
1. Please describe (separately) the overall development of your career to date, your aspirations for the next 5-10 years, and how you see the MBA relating to those aspirations.
2. Include a list of achievements (personal and career) of which you are particularly proud, on another page.
3. Your expectations of the MBA programme and Massey University in the MBA process.
4. A comprehensive and current curriculum vitae (CV).
5. Results of GMAT, IELTS and TOEFL tests as appropriate.
DECLARATION
I declare that to the best of my knowledge the information supplied above is correct and complete.
CANDIDATE’S SIGNATURE ... DATE: ...
