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SCP Application Form

The document is an application form for a training program. It requests information about the applicant such as personal details, employment history, education, emergency contacts, and a declaration agreeing to the terms. The applicant's direct supervisor and the National Focal Point for Technical Assistance of the nominating government must also endorse the application.

Uploaded by

Frida Adyasari
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© © All Rights Reserved
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Download as DOC, PDF, TXT or read online on Scribd
884 views

SCP Application Form

The document is an application form for a training program. It requests information about the applicant such as personal details, employment history, education, emergency contacts, and a declaration agreeing to the terms. The applicant's direct supervisor and the National Focal Point for Technical Assistance of the nominating government must also endorse the application.

Uploaded by

Frida Adyasari
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 4

Please type or write clearly in capital letters.

Do not leave
any space blank. Use NIL or N/A where applicable.
Programme:
Course Title:
Course Dates:
PART ONE: APPLICANT DETAILS (TO BE COMPLETED BY APPLICANT)

Applicant's Particulars
Title

Dr/Mr/Mrs/Ms/Others (please circle accordingly)

Family Name
Given Name
Gender

Date
of
(dd/mm/yy)

Birth

Nationality

Representing
Government of

Passport Number

Passport
Expiry
Date (dd/mm/yy)

Religion

Dietary Restrictions
(if any)

Contact Details
Country/Territory

State/Province

City/Town

Office Address
Postal Code
Country
Code

Area
Code

Number

Personal Email

Telephone No.
Mobile

Other Email

Fax No.

Person to be notified in case of emergency


Name

Relationship
Country Code

Area Code

Number

Telephone No.
Address
Email

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the National Focal Point for
Technical Assistance in your country/territory. Forms which are incomplete or not endorsed will not be accepted.

Employment History
Organisation

Department

Designation

Nature of Job

From
(dd/mm/yy)

To (dd/mm/yy)

PRESENT

Educational Qualifications
Educational Qualification Attained

Educational Institution

From
(dd/mm/yy)

To (dd/mm/yy)

Professional Qualifications
Description of Qualification

Date Attained

Previous Attendance
Have you attended any courses sponsored under the Singapore Cooperation Programme
previously? If yes, please state the name and date of course(s).

Yes/No

PART TWO: DECLARATION (TO BE COMPLETED BY APPLICANT)


NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the National Focal Point for
Technical Assistance in your country/territory. Forms which are incomplete or not endorsed will not be accepted.

I, ______________________________________________________ of ___________________________
Name of applicant

Representing Country/Territory

Declare that:
(a) All information provided is true, complete and accurate to the best of my belief and knowledge, and
that I have not wilfully suppressed any material facts;
(b) I am medically fit and free from any medical problems which may impair my ability to attend and
complete the training in Singapore;
(c) I am proficient in spoken and written English. (The course will be conducted in English. All
participants are expected to have a good working knowledge of the English language.); and
(d) I will be personally liable for all medical expenses incurred during my stay in Singapore, other than
those covered under the Group Personal Accident Insurance and Group Hospital & Surgical
Insurance policy.
(IMPORTANT NOTE: All successful participants are covered under Group Personal Accident and
Group Hospital & Surgical Insurance, which does not cover any pre-existing conditions/illnesses or
any outpatient medical/dental treatment. Participants are personally liable for all medical expenses
beyond what is covered by the insurance policy. As the coverage is limited, participants are advised
to make their own arrangements to obtain adequate medical insurance coverage for their stay in
Singapore.)
(e) (For pregnant applicants) I am______ months pregnant and am/am not certified by a qualified
doctor to be medically fit and in good health to travel and attend the training in Singapore;

I fully understand that if I fail to comply with the terms and conditions of the training award, and/or any of the
above declarations are found to be untrue, the award will be terminated with immediate effect and I will be
liable to depart from Singapore at my own expense.

________________________________
Date

_____________________________________________
Signature of applicant

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the National Focal Point for
Technical Assistance in your country/territory. Forms which are incomplete or not endorsed will not be accepted.

PART THREE: TO BE COMPLETED BY DIRECT SUPERVISOR


I nominate (Dr/Mr/Mrs/Ms*) ______________________ holding Passport No. _______________ for the
training course.
_____________________________________
Name and Designation

_____________________________________
Email Address

_____________________________________
Name of Organisation

______-___-____________
Country code Area code
Office tel no.

_____________________________________
Signature

______-___-____________
Country code Area code
Office fax no.

Please describe why the applicant has been nominated for this course:

Please describe what skills / knowledge you would like the applicant to gain from this course:

PART FOUR: ENDORSEMENT (TO BE COMPLETED BY NATIONAL FOCAL POINT


FOR TECHNICAL ASSISTANCE / MINISTRY OF FOREIGN AFFAIRS OF NOMINATING
GOVERNMENT)
By signing below, I confirm that I endorse the above nominee and that I believe all the statements in this
form to be correct.
_____________________________________
Name

(Ministrys Official Stamp)

_____________________________________
Designation

_____________________________________________
Name of Organisation

_____________________________________
Signature

___________-_________-________________________
Country code Area code
Office tel no.

_________________________________
Email Address

___________-_________-________________________
Country code Area code
Office fax no.

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the National Focal Point for
Technical Assistance in your country/territory. Forms which are incomplete or not endorsed will not be accepted.

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