1971-HKRS30-16-30_Part04 — Page 15

See NOTE I.

附一

See NOTE 2

愛

Particulars --

2.

詳細情節-

38

(2) Name (Mr./Mrs./Miss):

姓名(先生/夫人/小姐〕

{in English)

(in Chinese)

(* *)

(b) Aliases

別名

det Residential Address

住址

(d) Identity Card Number

身份

號

(c) Date of birth

出生日期

(f) Place of birth

出生地點

(g) Parlichlary of education

學歷篩憫

(0) Experience in or knowledge of educational matters

( Occupation

Other relevant information

其他凇關料

3. 1 affix above a signed full face photograph of myself and

本人在上面无上掘簸箝之本人正面半身照片

attach two signed copies of such photograph to this application.

•

The following persons who are/are not aware of the statements

+

made on this form may be referred to as regards my character and suita-

bility to be a manager-

(a) Name (Mr./Mrs./Miss) (甲)姓名(先生/夫人/小姐)

Address

地址

1

&肉

Occupation

(8) Name (Mr./Mrs./Misg)

(乙)姓名《先生/夫人/小姐了

Address

地址

Occupation

職業

39

5. The contents of this application are true and complete to the

best of my knowledge and belief.

確實無谶

(Signed)

申請人籟爆

NOTE : If the applicant has been convicted of a criminal offence 附註

affecting his character, or has been refused previously approva|

NOTE 2: 附註二

to be a manager, registration as a manager or teacher, or a

부

permit to teach as a permitted teacher, or bas had his approval

to be a manager withdrawn or his registration as a manager

or teacher or his permit to teach as a permitted teacher can-

celled, the full circumstances of such matter must be disclosed. 蹰口

Two referees are required. They must be persons of standing,

e.g. members of the Executive or Legislative Council. Justices 例如行政厨彧就

of the Peace, barristers-at-law, solicitors, ministers of religion, 法局,太平儿士。火律師, 律師 勖 chartered or incorporated accountants, persons on the list of 特許瘸師 " 特別將審名闞内 apecial jurors. registered reuchers, doctors or dentists, etc., and 且

*

+

must have known the applicant well for at least three years.

年 凹

-

WARNING. 瞥告

Attention is drawn to the provisions of the Education Ordinance 1971

and particularly to-

定尤豳注意

-

丸七

-

年戡常镲例之規定

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