中国国家原子能机构国际合作活动管理系统.docx

INTERNATIONA1.ATOMICENERGYAGENCY(EA>Wagramerstrasse，p.o.BOX100,Ai400Vienna(Austria)TE1.EPHONE(U31)2600.FACSIMI1.E：“431)26007EMAI1.:Offiaa.Mai1.<g>iaa.org,TCWEBSITE:http:'www-tc.wea.orgNOMINATIONFORTRAININGCOURSENour:Thisfm><nf*>1.bvusedk>a1.)forfr1.k>*iporMretti11cViXiITheCiovcrnmcnominates(beRntof>11.owingcandidatefor(heTniiningCoursen(indicateshort1.ide.p1.ace,da1.es.ProjCC1.cunicnumber):OFema1.eMa1.eDateofbirth:RcvcntphotographofcandidateFami1.yname:P1.aceofbirth:(osinfusspo11Naiiona1.iiy:Firstname:PassportNo.:COmPIetemai1.ingaddress1office):Dateofissue:inst.Name:P1.aceofissue:Va1.idunti1.:Street:Tc1.cphiinc(office):P.O.Box:IPostCode:Te1.ephone(home):Town.'Citv:Fax:RegirtnzDiMrici:e*mai1.:Country:WEBPage:AirportZtoMnnearesttoresidence:Enicrgcncvphone:EDUCATION<commrndngwithsecondaryschoo1.>YearsattendedNameandp1.aceofinstitutionFie1.dofstudyDip1.omaordegreefromtoRECENTEMP1.OYMENTRECORDYearsofSefVieNamea1.p1.aceofcmp1.oycr.'orcanizationTit1.eofPOSiIiOnTypeofworkfromtoDESCRIPTIONOFWORKTypeofworkdonebythecandidateduringthepast3years(P1.easeattach1.istofanymateria1.thecandidatemayhavepub1.ished)kIhCcundid<1.ecoveredunderaradi<1.kmSUrVCiHimMProgn1.m【neinhigherhomecountry?yesnoHas(hecaui>daebeen,orwi1.1.1.wsbebe,invo1.vedinanyIAEA-supportedTechnica1.Cfpcraiicnproject?(P1.easeidentifyprojectanddescribethenatu11jOf1.hecandidate'sinvo1.vement.)PREVIOUSPARTICIPATIONINANIAEAACTIVITY:I1.as1.hcCiIndKh1.CPartkipiUedinapreviousIAEA;ic1.ivi1.y?Ifyes.p1.ease1.istCad1.activitybe1.ow:RE1.EVANCEOFTHETRAININGHowisbeGovernmentgoingomakeuseOfIbe(miningreceivedby1.candidatea1.wcourse?1.ANGI；AGECERTIFICATEI,a*aqu1.ifrdbogUagCevmier.Itrvb>certifyIhMIhavC(WmiIIedI1.wabo*vCafK1.iudpvcIhv(<1.kuigin(<1111ai<fnhi1U>ruscqua1.fkuttn:(a>MotherIggUCofthecandidate:(b)O1.krIUIIgUQgCK(c>1.ingMgeoftecorscProficiencyinthe1.anguageofthecourseReadWriteSpeakUnders(axiGoodGOOdGoodGoodAverageAverageAverageAverageP(x1111PoorP<x>rJP<x>rDateNanic(printed)andsignatureofexaminerMEDICA1.CERTIFICATEI.Jrtftqihi1.ifiedmedia1.d<x.herebyocn1.IhUI1.tucCCimtfKd(hedtxvccdhcMk1.t<111.hinVherIn中XXihca1.h.freefrominfectiousandaMcPhySiCaIyandmenia1.1.yIocarryoutanyrr1.evantdutiesawayfromhi%,hcrhome.DateName(printed)andsignatureOfcxaminingphysicianGOVERNMENTSTATEMENTT1.wIiiXiiina1.ingGw11wugi*vs(hefu1.kmingaMnuve:a>A1.1.infkrmatnMPP1.iCdinthiformMCo1.nPktCandccc11xt:b1.Shou1.dthecnd>dacbngungcqun1.ifkuiuo。provetobeimufi1.cicnt«bou!dtheCndiihICMsuite(*hea1.thnotcorrespondotbeCXUmini咤P)MtiwSMa1.vitwii1.(hem)mia1.:Gvvrn111.«i1.1.就VCPfIherepmsibi1.i1.y(Of(he<mcqer>cc5undmi>>cn1.arising1.1.ercfm;OIti%na1.edththeon¾<>rinj<rpnizatia1.HCMcoumtjX>c%>andIK1.ainui1.ucio<%>dono<acorp(1.iabi1.ityforhepaymentof®yOMbIar<omcwwn。"所£fromtoorIOfAofPCM“1PGWn八arfromI1.1.ness,injury,dab11yxdehofaPUrIH1.(UnIwhi1.ehe,ctInIVeHi吨toandfrom<»rM1.Cndingth<IrUining«»unc.andit.Ihcn>miu1.inGwenifnenc,undertakesthervsponibi1.iyRIrSUCh>vcrc;dIThep<>MtionfthecAndidutcwi1.1.berencdforhim,hcrndhe*shewi1.1.continueidreceiveduringthetrainingcour¾cM1.bryJndrebtcdCmohmICngk>enab1.eIitnvYwr(>mec<hiherfMKwiemmi1.nmginhi'1.efbotcountry;c>Ifse1.ected,thenomineewi1.1.conducthi11iMr1.fcrc1.finamannerComPMibkwithhi<bcrrtatuiasaPaniCiPUfUandwi1.1.refrainfromendinginMypo1.itca1.andCOmmCsiX(MnMONo(cImSrek(wnIDUIeGovcmfiiemrvgan1.ig(hervhbi1.i(yandchar*r(0o1.u11Mkun(WhiehW1.M1.kICbMnKIgivinghithcacv¼K>nuc1.earintiJbciiMiserinxiu<ie(kwhereionizingraduu<)<isued.DateNameandtit1.e(printed)andsignatureofcertifyingGovernmentOfYicia1.