Application for Higher Diploma in Nursing - DOC by Zf2cT6j

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									           社福界登记护士(普通科)/登记护士(精神科)训练课程入学申请表
                             Application for Admission to
      Enrolled Nurse (General) / Enrolled Nurse (Psychiatric) Training Programme
                                 for the Welfare Sector

备注:                                    Notes:
1. 请以英文正楷填写此申请表。填写此申请表时,请              1.   Please complete the application form in English and print in BLOCK
   参考申请须知。                                  LETTERS and refer to the Guide to Applications when completing
                                            the application form.

2.    每名申请人只可申请报读登记护士(普通科)训练           2.       Each applicant may only apply for admission to either the Enrolled
      课程或登记护士(精神科)训练课程。                         Nurse (General) training programme or the Enrolled Nurse
                                                (Psychiatric) training programme.
3.    申请人应于二零零六年五月二十三日或以前,把填           3.       Completed application forms, together with copies of education
      妥的申请表,连同在香港取得的学历证书副本、在                    certificates for the qualifications obtained in Hong Kong and outside
      香港以外的地方取得的学历证书副本及证明其具                     Hong Kong, documentary proof of the Hong Kong equivalent of the
      备等同于香港有关学历的文件(如适用)及现时于社                   education attainment obtained outside Hong Kong (if applicable) and
                                                documentary proof of an existing full time employment in the welfare
      福界担任全职雇员的证明文件(如适用),邮寄(以邮
                                                sector (if applicable), should be submitted to the Social Welfare
      戳为凭)或亲身递交(于二零零六年五月二十三日下                   Department, Room 835, 8/F, Wu Chung House, 213 Queen’s Road
      午五时正或以前 – 香港时间)香港湾仔皇后大道                   East, Wan Chai, Hong Kong on or before 23 May 2006 either (i) by
      东 213 号胡忠大厦 8 楼 835 室社会福利署。信封上            post (according to postmark) or (ii) by hand (at or before 5:00 p.m. on
      应注明「申请报读社福界登记护士训练课程」        。             23 May 2006 – Hong Kong time). The envelope should be marked
                                                “Application for Enrolled Nurse Training for the Welfare Sector”.
4.    申请人在递交填妥的申请表时,必须夹附在申请表           4.       Applicant must attach to the completed application form copies of the
      上所呈报的有关学历的证书副本(包括在香港本地                    education certificates for the qualifications entered in the application
      或香港以外的地方所取得的学历)。                          form, including those obtained in Hong Kong and outside Hong Kong.

5.    如申请人在香港以外的地方取得学历,须向社会福           5.       For education attainment obtained outside Hong Kong, applicants are
      利署递交证明其等同于香港有关学历的文件,否则                    required to submit to the Social Welfare Department documentary
      社会福利署将无法考虑该学历。                            proof of its Hong Kong equivalent; otherwise, the Social Welfare
                                                Department will not be able to consider that education attainment.

6.    现时全职在社福界工作的申请人,须于申请表内夹           6.       Applicant currently working full time in the welfare sector should
      附显示其现时雇主机构名称、服务单位名称、职位                    attach to the application form documentary proof showing the name of
      名称及其为全职雇员的证明文件。未有提供上述证                    the employing organisation, the name of the service unit where the
      明文件的申请,在遴选过程中将不获优先考虑。                     applicant is working, the position held and the full time nature of the
                                                employment. Applications without the above documentary proof
                                                will not be accorded priority in the shortlisting and selection process.

7.    在以下任何一种情况下,申请将不获处理 –     7.               Applications will not be processed under any of the following
      (a) 未有在申请表上指明报读登记护士(普通科)                  circumstances –
          训练课程或登记护士(精神科)训练课程;                   (a) application with no indication of which training programme,
          或                                          namely either EN(General) training programme or
      (b) 同时报读登记护士(普通科)训练课程及登                        EN(Psychiatric) training programme, the applicant is applying
                                                     for; or
          记护士(精神科)训练课程;或
                                                (b) application indicating admission to both EN(General) training
      (c) 未有提供学历证书副本;或                               programme and EN(Psychiatric) training programme; or
      (d) 申请人未有在申请表上签署;或                        (c) application with no attachment of copies of education certificates;
      (e) 逾期递交的申请。                                   or
                                                (d) application without the applicant’s signature; or
                                                (e) late application.
8.    申请人如希望获知社会福利署已收到其申请表,请           8.       Please supply a stamped self-addressed envelope if you wish to
      附上一个已贴上邮票及填妥地址的回邮信封。                      receive an acknowledgement of receipt of your application from the
                                                Social Welfare Department.
9.    此申请表内所收集的个人资料会用作处理申请报            9.       The personal data collected in this application form will be used for
      读本训练课程之用。                                 the purpose of processing the application for admission to the training
                                                programme.

10.   提交申请表后,如欲查阅或更正个人资料,请在办           10.      For access to or correction of personal data after submission of this
      公时间内联络社会福利署 (电话:2110 1495)。               application, please contact the Social Welfare Department (Tel. No.:
                                                2110 1495) during office hours.

                                            -   1   -
甲部     申请课程          SECTION A         PROGRAMME APPLIED FOR                             For office use only
本人欲申请入读 (请只“”一项)                                                                        Reference Information
I wish to apply for admission to (Please “” one only)
      □       社福界登记护士(普通科)训练课程。
              Enrolled Nurse (GENERAL) Training Programme for the Welfare Sector.
      □      社福界登记护士(精神科)训练课程。
              Enrolled Nurse (PSYCHIATRIC) Training Programme for the Welfare Sector.

乙部      个人资料         SECTION B          PERSONAL PARTICULARS
 英文全名 Full Name in English                           中文姓名 Name in Chinese

                                                                                                      近照#
 性别 Sex       出生日期 Date of birth                     香港身份证号码
                                                                                                      Photo#
              (日/月/年)(dd/mm/yyyy)                    HK Identity Card No.
 男 / 女*
 M / F*

 住址 Residential Address


 通讯地址 Correspondence Address (如与上址不同 If different from the address given above)


 住所电话号码            办事处/日间联络电话号码                  流动电话号码                   传真号码          电子邮件地址
 Residential       Office/Day Time Contact No.   Mobile Phone No.         Fax. No.      Email Address
 Telephone No.


 * 请删去不适用者 Please delete as appropriate.
 # 可选择不提供 Optional

 丙部      曾受教育(按最早日期顺序列出) SECTION C                                       EDUCATION (In chronological order)

        曾经就读的学校(中学/专上)                                             班级                                年
      Schools Attended (Secondary/Tertiary)                        Form                             Year


 在香港就读 In Hong Kong                                                 至                                至
                                                                    To                               To
                                                                    To                               To
                                                                    To                               To
                                                                    To                               To
                                                                    To                               To


 在香港以外地方就读 Outside Hong Kong                                        至                                至
                                                                    To                               To
                                                                    To                               To
                                                                    To                               To
                                                                    To                               To
                                                                    To                               To




                                                       -   2   -
丙部       曾受教育(续) SECTION C                                EDUCATION (Continued)
                                                                                                          (只供有关部门填写)
          香港中学会考与考科目                                            香港高级程度会考与考科目                               (For office use only)
          (只填写最高等级)                                               (只填写最高等级)
        HKCEE SUBJECTS TAKEN                                    HKALE SUBJECTS TAKEN
          (Highest Grade Only)                                    (Highest Grade Only)                           Photocopies of:

 年份                   科目                   等级            年份                    科目              等级
 Year                Subject               Grade         Year                 Subject           (注 1)     - HKCEE
                                                                                               Grade      (Yr.                Y/N)
                                                                                               (Note 1)
                                                                                                          (Yr.                Y/N)
                                                                                                          (Yr.                Y/N)
           English Language (Syl. A)                            Use of English                            (Yr.                Y/N)
           English Language (Syl. B)                            Chinese Language and Culture
           Chinese Language                                     Pure Mathematics                          - HKALE

           Mathematics                                          Applied Mathematics                       (Yr.                Y/N)
                                                                                                          (Yr.                Y/N)
           Additional Mathematics                               Mathematics and Statistics
                                                                                                          (Yr.                Y/N)
           Physics                                              Physics                                   (Yr.                Y/N)
           Chemistry                                            Chemistry
           Biology / Human Biology                              Biology
                                                                                                          - HKHLE
           Chinese History                                      Chinese History
                                                                                                          (Yr.                Y/N)
           English Literature                                   English Literature
                                                                                                          (Yr.                Y/N)
           Chinese Literature                                   Chinese Literature                        (Yr.                Y/N)
           Computer Studies                                     Computer Studies
           Geography                                            Geography
                                                                                                          - GCE (A/O)
           Economics                                            Economics
                                                                                                          (Yr.                Y/N)
           History                                              History
                                                                                                          (Yr.                Y/N)
           Others: (Please specify)                             Others: (Please specify)                  (Yr.                Y/N)



                                                                                                          - Other Certificate(s)
        香港高等程度会考与考科目                                             普通教育文凭试与考科目                              (Yr.                Y/N)
          (只填写最高等级)                                                (只填写最高等级)                              (Yr.                Y/N)
        HKHLE SUBJECTS TAKEN                                GCE (A/O Level) SUBJECTS TAKEN
          (Highest Grade Only)                                    (Highest Grade Only)

 年份                   科目                   等级            年份        程度                 科目       等级
 Year                Subject               Grade         Year     Level              Subject   Grade
                                                                  (A/O)




注 1: 包括高级程度及高级补充程度科目的等级
Note 1: Including grades at both A-level and AS-level.

                                                                  -   3   -
                                                                                                                       For office use only
                                                                                                                       Currently Working in
                                                                                                                       Welfare Sector      □
丁部        工作经验 (按最早日期顺序列出)
SECTION D             WORK EXPERIENCE (In chronological order)
        机构名称                                                                                                      日期(日/月/年)
                                                       注 2)
    Name of Organisation             服务单位名称(                        工作性质                                           Date (dd/mm/yyyy)
                                                                       (注 3)                  职位
                                                                                          Position Held
                                      Name of Service             Nature of
                                                                                                                    由               至
                                        Unit (Note 2)          Employment (Note 3)
                                                                                                                   From             To
                                                              全职/兼职
                                                              Full-time/Part-time
                                                              全职/兼职
                                                              Full-time/Part-time
                                                              全职/兼职
                                                              Full-time/Part-time
                                                              全职/兼职
                                                              Full-time/Part-time
                                                              全职/兼职
                                                              Full-time/Part-time
                                                              全职/兼职
                                                              Full-time/Part-time
注 2: 如曾经或正在福利机构工作,请注明服务单位名称。
Note 2: For an applicant previously/currently working in the welfare sector, please also indicate the name of the service unit.
注 3: 请删去不适用者。
Note 3: Please delete as appropriate.


戊部        补充资料             SECTION E             SUPPLEMENTARY INFORMATION
补充资料详情 Details of supplementary information
你可在下栏提供其他相关资料,惟务须简要,请勿附加纸张。
You may provide information which you consider is relevant to your application.                       Please be concise and confine the
information to the space provided. Do not use any additional sheet.




声明 Declaration
本人谨此声明,在本申请表填报的资料均正确及完备。本人明白填报的资料会用作处理申请报读本训练课程之用;若填
报的资料失实,本人的入学申请及注册资格将被取消。
I declare that the information given in this application form is, to the best of my knowledge, accurate and complete. I
understand that this information will be used for processing my application for admission to the enrolled nurse training
programme and that any misrepresentation may lead to disqualification of my application for admission and cancellation of
subsequent enrolment.

签名                                                                  日期
Signature:                                                          Date:




社会福利署 Social Welfare Department
二零零六年四月 April 2006


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