1952-HKRS29-8-19_Part02 — Page 39

Let Sal, conid)

FORM 4

[a. 21.

[int Sch, canda.

12. The following persons may be referred to us to my character-

(*) Name

(6) Name

Address Address

THE EDUCATION ORDINANCE, 1952.

* Application for registration as a teacher,

Director of Education,

Education Department,

HONG KIN

Address

Date

1. I submit particulars of myself and request you to register me as

a teacher and to issue me with a certificate of registration.

2.

Particulars

() Name in English

(b) Name in Chinese

(c) Aliases

(d) Seat

(e) Whether married or single

4.

$5.

I attach-

(a) two signed photographs of myself;

(b) medical certificate;

(*) educational certificates.

I declare that-

(a) I am a person of good character;

(b) I have mover previously been refused registrallon as a manager of any school or as a teacher or been refused permission to teach or having been so registered or given permission to teach bad my registration or permission cancelled.

6.

The contents of this application are true to the best of my know- ledge, information and belief.

(Signed)

* Note 1. Thin foren la oppnexpriate only in the case of persons who possese che qualfentions

ent out in regalation a† of the regalatiana.

↑ Note 1. Two referees jura requined. They must be petsons of standing #t. number

of Executice or Legislative Commstl. Jartico of the Peace, bariatrm=pt-]ww. balto, minister of religion, chartered or incorporndent meccatanti, pormona on the specfal Jury 1st, or reglitered doctors pe dentials, and should därtilly have known the applicant well for at levert three years.

*Note 1. T educational certifestes are not available at the time of the application, (c) should be deleted and applicant may be required to produce them later or impection.

I Note 4. It wpplienne has hoon convicted of a griminal offenes affecting hla character

or rebused reglilention etc. the full aircumstansea must be disclosed,

(/) Date of birth

(9) Place of birth

(k) Whare educated with dates-

School or University

(1) Educational qualifications

(7) Previous teaching experience-

School

28

From

Fo

Classes taught

Subjects taught

FORM 5

[a. 22.

THE EDUCATION ORDINANCE, 1962,

Certificate of registration of teacher.

This is to certify that

----f-

whose photograph is affixad hereto has been registered as a teacher under the Education Ordinance, 1952.

Photograph

mf

bolder

Director of Education.

Hoan Hong

12.