PART 1第一部分 COURSE APPLICATION课程报名表格

1、Page 1 of 4贴上近照 Attach Photo PART 1第一部分: COURSE APPLICATION课程报名表格Course(s) Applied for申请课程Start Date开课日期End Date毕业日期(A) PERSONAL PARTICULARS个人详情Name as in NRIC (in Block Letters, underline Surname):身份证姓名（大写字体，姓氏下划线）Mr 先生女士：Dr博士Ms女士Name(姓名：汉语拼音)姓名（中文名）Passport No:护照号码Citizenship: 国籍Gender:Date of Bir

2、th (dd/mm/yy)Race (Optional)Religion (Optional)性别出生日期（日/月/年）籍贯（可省略）宗教（可省略）F女M男 Mailing Address通讯地址:Country国家: Postal Code邮编号码: Province/ State省/州:Page 2 of 4SCHOOL OF HEALTH SCIENCES保健护理科学系Important重要信息Please read all the instructions carefully before proceeding. 在填表之前请详读全部指示说明。An inaccurate or inco

3、mplete form may render your application invalid. 不属实或不完整填写的表格将当作申请无效。Supporting documents (certificates, transcripts, etc) must be submitted with your application. 所有证件（证书、抄本等）在报名时一并呈交。Please write clearly and legibly. 请仔细书写确保字迹清晰。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谨此声明表格一旦呈交，申请者同意遵守南洋理工学院(“NYP”)网站.sg内所规定的条例Employer雇主:Designation职位:Department部门:Phone Country Code: Phone Area Code: 国家电话代码 区域电话代码 Office Tel No公司电话.:Office Fax No公司传真.:Mobile Phone No.手机号码:Home

5、Tel No.住宅电话:Email Address电邮地址:Alternative Email address替代电邮地址:Page 3 of 4(B) PROFESSIONAL QUALIFICATIONS学历Institution 学院Qualification 学历Date (mm/yy) 日期（日/月/年）From从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：请附上所有详细证书抄本的影印副本作为上列学历的证实文件。(C)WORKING EXPERIENCE IN NURSING IN THE LAST 3 -Years过去3年的护理工作经验(in chronological order, starting from current employment)（年月日顺序，从目前就业机构开始）If space is not enough, please attach a separate sheet.如空格不足填写，另添加附件。Organisation公司Designation职位

7、From从To至Brief Job Description简述工作情况 (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).备注：您可以附上有关您的工作经验的文件。 (例如：履历表或任何的重要任务/完成项目等。)Page 4 of 4(D)PERSONAL GOALS 个人目标_(E)ORGA

8、NISATIONS GOALS 派遣单位目标_(F) DECLARATION BY APPLICANT 申请者声明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.我谨声明以上所填写的资料准确并全部属实、亦无故意省略任何相关事实。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.我谨同意遵守南洋理工学院对此申请所作出的决定以及接受学院不须提出任何理由，保留取消、延期课程的权力。- - - Name Signature DateNOTE:备注：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.南洋理工学院国际有限公司(“NYPi”)，完全自主并附属于南洋理工学院，与海南省公共卫生署(“HPHB”)共同协力为提升海南省的护理水平筹备项目。此课程即项目中的一个组成部分。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