PART 1第一部分 COURSE APPLICATION課程報(bào)名表格

1、Page 1 of 4貼上近照 Attach Photo PART 1第一部分: COURSE APPLICATION課程報(bào)名表格Course(s) Applied for申請(qǐng)課程Start Date開(kāi)課日期End Date畢業(yè)日期(A) PERSONAL PARTICULARS個(gè)人詳情Name as in NRIC (in Block Letters, underline Surname):身份證姓名（大寫(xiě)字體，姓氏下劃線）Mr 先生女士：Dr博士Ms女士Name(姓名：漢語(yǔ)拼音)姓名（中文名）Passport No:護(hù)照號(hào)碼Citizenship: 國(guó)籍Gender:Date of Bir

2、th (dd/mm/yy)Race (Optional)Religion (Optional)性別出生日期（日/月/年）籍貫（可省略）宗教（可省略）F女M男 Mailing Address通訊地址:Country國(guó)家: Postal Code郵編號(hào)碼: Province/ State省/州:Page 2 of 4SCHOOL OF HEALTH SCIENCES保健護(hù)理科學(xué)系Important重要信息Please read all the instructions carefully before proceeding. 在填表之前請(qǐng)?jiān)斪x全部指示說(shuō)明。An inaccurate or inco

3、mplete form may render your application invalid. 不屬實(shí)或不完整填寫(xiě)的表格將當(dāng)作申請(qǐng)無(wú)效。Supporting documents (certificates, transcripts, etc) must be submitted with your application. 所有證件（證書(shū)、抄本等）在報(bào)名時(shí)一并呈交。Please write clearly and legibly. 請(qǐng)仔細(xì)書(shū)寫(xiě)確保字跡清晰。Through the submission of this form, the applicant is deemed to have

4、agreed to abide by the Nanyang Polytechnic (“NYP”) Privacy Policy as stated in .sg謹(jǐn)此聲明表格一旦呈交，申請(qǐng)者同意遵守南洋理工學(xué)院(“NYP”)網(wǎng)站.sg內(nèi)所規(guī)定的條例Employer雇主:Designation職位:Department部門(mén):Phone Country Code: Phone Area Code: 國(guó)家電話代碼 區(qū)域電話代碼 Office Tel No公司電話.:Office Fax No公司傳真.:Mobile Phone No.手機(jī)號(hào)碼:Home

5、Tel No.住宅電話:Email Address電郵地址:Alternative Email address替代電郵地址:Page 3 of 4(B) PROFESSIONAL QUALIFICATIONS學(xué)歷Institution 學(xué)院Qualification 學(xué)歷Date (mm/yy) 日期（日/月/年）From從To至IMPORTANT: Photocopies of your detailed transcripts (up to module level grades) must be attached as supporting documents for your acad

6、emic qualification listed above.重要信息：請(qǐng)附上所有詳細(xì)證書(shū)抄本的影印副本作為上列學(xué)歷的證實(shí)文件。(C)WORKING EXPERIENCE IN NURSING IN THE LAST 3 -Years過(guò)去3年的護(hù)理工作經(jīng)驗(yàn)(in chronological order, starting from current employment)（年月日順序，從目前就業(yè)機(jī)構(gòu)開(kāi)始）If space is not enough, please attach a separate sheet.如空格不足填寫(xiě)，另添加附件。Organisation公司Designation職位

7、From從To至Brief Job Description簡(jiǎn)述工作情況 (mm/yy)（月/年）Note : You may wish to attach any additional details pertaining to your work experience (e.g. resume or write-up on any significant assignment/project completed, etc).備注：您可以附上有關(guān)您的工作經(jīng)驗(yàn)的文件。 (例如：履歷表或任何的重要任務(wù)/完成項(xiàng)目等。)Page 4 of 4(D)PERSONAL GOALS 個(gè)人目標(biāo)_(E)ORGA

8、NISATIONS GOALS 派遣單位目標(biāo)_(F) DECLARATION BY APPLICANT 申請(qǐng)者聲明1.) I declare that all the information given in this application form are true and accurate to the best of my knowledge. I have not deliberately omitted any relevant fact.我謹(jǐn)聲明以上所填寫(xiě)的資料準(zhǔn)確并全部屬實(shí)、亦無(wú)故意省略任何相關(guān)事實(shí)。2.)I agree to abide by the Polytechnics

9、 decision concerning this application and I accept that the Polytechnic reserves the right to cancel or postpone the course without giving any reasons.我謹(jǐn)同意遵守南洋理工學(xué)院對(duì)此申請(qǐng)所作出的決定以及接受學(xué)院不須提出任何理由，保留取消、延期課程的權(quán)力。- - - Name Signature DateNOTE:備注：Nanyang Polytechnic International Pte Ltd (“NYPi”), a wholly-owned

10、 subsidiary of Nanyang Polytechnic (“NYP”), in conjunction with Hainan Public Health Bureau (“HPHB”), has prepared a Programme to help improve the standard of nursing in Hainan. This course is part of the abovementioned Programme.南洋理工學(xué)院國(guó)際有限公司(“NYPi”)，完全自主并附屬于南洋理工學(xué)院，與海南省公共衛(wèi)生署(“HPHB”)共同協(xié)力為提升海南省的護(hù)理水平籌備項(xiàng)目。此課程即項(xiàng)目中的一個(gè)組成部分。Nanyang Polytechnic reserves the right to make changes to the class/schedule or any details pertaining to the course without prior notice to the participants. Receipt of an applicatio