Singapore Computer Society

Name of Employer:

Date joined:

List all positions held in company:

Date left:

Description of work:

Reason for leaving:

30th July 2010 Friday

APPLICATION FOR SCS-YP MENTORING PROGRAM

Instruction:
Please complete the form in BLOCK LETTERS.

PERSONAL PARTICULARS

NAME as in NRIC & underline surname (MR / MRS / MISS / MADAM)

SCS Membership No

CHRISTIAN NAME (if any)

Sex(M/F)

MARITAL STATUS

ADDRESS (BLK NO, ROAD NAME, UNIT NO)

POSTAL CODE

NRIC / PASSPORT NO.

TELEPHONE (Home)

TELEPHONE (Office) Extension

PAGER / HANDPHONE

BIRTH DATE (DDMMYY)

PLACE OF BIRTH

NATIONALITY

If non-Singaporean, please tick residential status :
Singapore Permanent ResidentEmployment PassWork PermitDependant PassSocial Visit Pass

EDUCATION AND TRAINING

STANDARD	NAME OF SCHOOLS / COLLEGES	LANGUAGE	DATES		CERTIFICATE / DIPLOMA /DEGREE AWARDED
STANDARD	NAME OF SCHOOLS / COLLEGES	LANGUAGE	FROM	TO	CERTIFICATE / DIPLOMA /DEGREE AWARDED
SECONDARY
PRE-U/COLLEGE
TERTIARY

OTHER TRAINING / PROFESSIONAL COURSES OR SKILLS (e.g. computer knowledge)

CURRENT STUDIES (if any)

EMPLOYMENT HISTORY (Starts with the most recent and work backwards)

REFERENCES [Please give 2 persons (not relatives) whom reference may be made]

Name	Address	Telephone	Occupation

MEMBERSHIP OF PROFESSIONAL / TECHNICAL BODIES, SOCIETIES OR CHURCH ETC.

EXTRA-CURRICULAR ACTIVITIES IN SCHOOL

Please give any other relevant particulars about your career and achievements and any other information you would like to give about yourself or your experience.

DECLARATION

I declare that the information given in this application is true and complete. I understand any misleading information, falsification or wilful omission is sufficient reason for termination of the program.

Yes. I agreed with the above declaration.
No. I do not agree with the above declaration.