Transcription
Union Hospital - School of NursingDiploma in General Nursing (Enrolled Nurse) (ENApplication Form-)Please complete all relevant parts in English BLOCK LETTERS and put a tick "3 "in the box as appropriate.I. Personal ParticularsName in English:(Surname)PHOTO(Other Names)HEREName in Chinese:(HKID No.:/Date of Birth:dd)Age:/mmSex: M FyyyyResidential Address:Correspondence Address (if different from above):Mobile Phone No.:Residential Telephone No.:E-mail Address:How do you know about this course? Hospital Web Site School of Nursing Web Site Newspaper, please specify: Friend / Relatives, please specify: Others, please specify:SON-001-12-2680(R)For Office Use OnlyDate Received:Applicant Number: Incomplete Information Interview Date: ( Unmatched with ER Above EREN---A//)Handled by: Orientation Date: (//) Waiting List Body Check Date: (//) Not Selected Enrollment Date: (//) MatchedEffective since 15-06-2012Approved by School PrincipalPage 1 of 4
Union Hospital - School of NursingII. Qualification and Training (in chronological order)Please continue on a separate sheet if necessary.FromTo(Month/Year)(Month/Year)HKCEE Subjects PassedYearSubjectGrade /Level*School/ College/ UniversityHKDSE Subjects Passed**YearSubjectGrade /Level*Qualification ObtainedHKALE Subjects Passed†YearSubjectGrade /Level*Points to note:* List the highest grade / level for each subject.** Submit examination result within 3 working days after announcement. Fax no.: 2605 3880.SON-001-12-2680(R)† Specify whether the subjects passed in the HKALE, if any, are of Advanced Level (AL) or AdvancedSupplementary Level (AS).Effective since 15-06-2012Approved by School PrincipalPage 2 of 4
Union Hospital - School of NursingIII. Relevant Work Experience in Healthcare Industry (in chronological order)Please continue on a separate sheet if necessaryFromTo(Month/Year) (Month/Year)Name of Healthcare Institute /OrganizationFull / PartTimePositionReason ofResignationIV. Notes1. Personal Data provided in this form will be used for processing your application for admission, and for academic,administrative and statistical purposes. Please be assured that any personal information you supply will bekept strictly confidential.2. When the processing and consideration of all the applications have been completed, the application andsupporting documents of unsuccessful candidates will be kept for no more than 3 months and destroyedafterwards.V. Declaration I declare that all information given in this application form and attached documents are, to the best of my knowledge,accurate and complete. I consent that, if registered, I will conform to the regulations and rules of the School. I have also noted, understood and agreed to the contents of the Notes above and the School policies on rks:1.Application Fee: HK 300 payable to 「Union Medical Centre Limited」Hang Seng Bank Account no.: 249-050436-6682.Your application will not be considered if you fail to provide all information as requested.3.For academic qualification obtained outside Hong Kong, you are required to submit to the School of Nursing adocumentary proof of its Hong Kong equivalent; otherwise the School will not be able to consider such qualification.You can refer to the website of the Hong Kong Council for Accreditation of Academic & Vocational Qualifications(HKCAVVQ) for details.Effective since 15-06-2012Approved by School PrincipalPage 3 of 4
Union Hospital - School of NursingReminder to Applicants1. Please make sure you have enclosed the following documents with your completed application form: One photo (Passport size) Copies of certificates for academic qualification(s) and working proof(s) Original Bank-in slip of application fee-HK 300 payable to 「Union Medical Centre Limited」Hang Seng Bank, Account no.: 249-050436-668-Applicant's FULL name, and the course code at the back of the bank-in slip2. Application documents should be sent to the following address:School of Nursing,Union Hospital,18 Fu Kin Street,Tai Wai, Shatin-)]SON-001-12-2680(R)[ Application for Diploma in General Nursing (Enrolled Nurse) (EN-Effective since 15-06-2012Approved by School PrincipalPage 4 of 4
School of Nursing, Union Hospital, 18 Fu Kin Street, Tai Wai, Shatin [ Application for Diploma in General Nursing (Enrolled Nurse) (EN- - )] SON-001-12-2680(R) Effective since 15-06-2012 Approved by School Principal Page 4 of 4 . Title: SON001r.XLS Author: 0936 Created Date:
