1971-HKRS30-16-30_Part04 — Page 22

52

Address for correspondence (ise NOTE 1)

通訊地址

CMM-)

53

PART H.

第二部份

(To be completed by the person to be employed as a permitted teacher.)

Telephone Number

Date TO.........IS

日期

The Director of Education,

Education Department,

Hong Kong.

慢致香港教育而,

㶅脾者:

1. I request permission to equploy-

%

Name (Mr./Mrs./Miss);

姓名「先生,夫人/小姐)

(in English)

(**)

(in Chinese)

中

as a permitted teacher in the

嚚准用

在

Proposed subjects to be

taught by such person;

(00) (iii)

School.

學校任戱¤

Proposed classes to be

taken by such person:

3. Proposed monthly salary of such persON:

-

擬盥鹣装敢岛之月薪篇

fa my opinion, there is no suitable registered teacher available for

employment as a teacher in the school.

5. The particulara relating to such person and set out in Part II of 據本人所知,在本 表格第二部份所城 this form are true and complete la the best of my knowledge and belief.

(Signed')

簽署

(Supervisor, or applicant

for registration of school).

Signed full face

在此貼上

photograph of

proposed teacher to

貝簸署忠正面

be affixed here.

1.

I, the person referred to in Part I of this form, forward the 本人即本爽鞯孵 following particulars of myself-- 祥翻情節開列如下一

(α) Name (Mr./Mrs./Miss):

姓名[先生/夫人小姐)

(in English) ......

(in Chinese)

(4 *)

(5) Aliases

(0) Residential Address

住址

(4) Identity Card Number

(e) Marital status: Married/Single

() (0 Maiden name

婚镢前哭姓名

(0) Husband's came 窯考姓名

(g) Date of birth

出生日期

(b) Place of birth

冊申趺,

出生地點

See NOTE 2

註