Application Form Sample

A. Personal Particulars
Affix a self-attested
Name in full (English):
passport size
(Chinese):
photograph
Identity Card Number: ( )

Residential Address:

School:

Form:

Date of Birth (DD/MM/YY):

Contact Number: _

Email:

B. Achievements
List in chronological order no more than ten academic achievements attained in

the past three years. Please attach additional sheets if necessary and provide

supporting documents.
Year Name of Award Organization
Awarded

1
C. Extra-curricular Activities and Community Services
List in priority order no more than ten extra-curricular activities and community
services participated in the past three years. (Please attach additional sheets if
necessary.)
Year Name of Activity Post / Responsibility Organization

D. Personal Statement
Please include a statement of not more than 500 words in English on your
explanation for introducing yourself in aspects leadership and follower, either
typewritten or legibly written. This statement (in Annex I) is to be attached to the
Application Form.

E. Referee
Name one person who has agreed to give reference about you. If possible, he or
she should be or has been your teacher / tutor. The referee statement (in Annex II)
should be submitted together with your application form.
Name: ____________________________________________________Title: __________________
Organisation:____________________________________ Position:
__________________________
Tel no:_______________________ Fax no:_________________
Email:_______________________

F. Declaration

1. I declare that I have the right applying for the program.

2. I declare that the information supplied in this application and the
supporting documentation is true and complete.
3. I also agree that my information provided may be released to
interviewers for consideration.

Signature of Applicant: Date:

2
Annex I

Statement by Applicant on reasons for participating this

programme

(Use additional sheets if necessary, and duly sign on each page)

Name of Applicant:

Signature:

Date:
Annex II

Statement by Referee

(Use additional sheets if necessary, and duly sign on each page)

Name:

____________________________________Title:____________________________

Organisation:______________________________ Position:

_________________________

Tel no:_______________ Fax no:______________

Email:___________________________

Date:
Please also note that the candidate has the right of access to the
assessment provided by you in accordance with the provisions of the
Personal Data (Privacy) Ordinance.