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1、1 CIP-SA花旗集團大學生社責實踐花旗集團大學生社責實踐 20092009Citi Community Intern Program主辦及贊助: Organizer & Sponsor:合辦: Co-organizer:學生報名表格學生報名表格 Application Form for Students填表須知Notes: (1)申請人須提供正確資料。Please ensure that the information provided is accurate. (2)申請人如未能提供所需資料，申請可能 不獲辦 理。 Your application may not be consider
2、ed if you fail to provide the requested information. (3)申請人所提供的資料，將用於與 上述實習計劃有關事宜上。The information provided will be used for purposes related to the above-mentioned Program. (4)提交 報名 表後，如欲更改或查詢個人資料，請與上述實習計劃秘書處聯絡。For correction of or access to personal data after submission of the application form, p
3、lease contact the Secretariat of the above-mentioned Intern Program.申請人編號 Candidate No.: (內部填寫 Official use only)第一部分第一部分個人資料個人資料 （請以英文正楷填寫）（請以英文正楷填寫） Part 1Personal Particulars (Please fill in ENGLISH using block letters) 姓名 Name: (中文 Chi) (英文 Eng) 所屬大學 University: 學生編號 Student ID no.: 學系 Faculty:
4、主修學科 Major Study: 現時就讀年級： 2 / 3 * 年級 Current Year of Study: Year 2 / 3 * 出生日期 Date of Birth: / / (日 D /月 M / 年 Y) 性別 Sex: 男 M / 女 F*國籍 Nationality: 香港身份證號碼/護照號碼 HKID No./ Passport No.*: 電郵 Email: 聯絡電話(住所) Residential Tel. No.: 流動電話 Mobile phone No.: 通訊地址 Correspondence Address: 緊急聯絡人 Emergency Conta
5、ct: 關係 Relationship: 電話 Tel: *請於適當方格中表示 Please put a cross in the appropriate box. * 如屬本港居民，請提供香港身份證號碼。Please fill in your HKID No. if you are a Hong Kong Citizen. 第二部分第二部分參與其他實習計劃參與其他實習計劃/義務工作經驗義務工作經驗 Part 2Relevant Internship Experience/Volunteer Community Services 1.你曾否參與由其他機構舉辦的實習計劃? (請按參與日期順序列出
6、最近期三項) Have you ever joined an internship organized by other organizations/employers? (Please place the 3 most recent items in chronological order.) 日期 Date 由 From 至 To(Month/Year) (Month/Year)實習計劃名稱 Name of Internship Program 工作內容 Responsibilities主辦機構/僱主 Organizer/EmployerSurname Given Name 姓氏名字截止提
7、交日期 Submission Deadline: 30 September 20092 CIP-SA2.你有否任何工作經驗 (包括暑期工及兼職)? (請按任職日期順序列出最近期三項) Do you have any previous working experience (including summer employment & part-time jobs)? (Please place the 3 most recent items in chronological order.) 日期 Date 由 From 至 To(Month/Year) (Month/Year)職位 Positi
8、on 工作內容 Responsibilities僱主 Organizer/Employer3.請簡述你過往曾參與的課外活動、義務工作經驗，以及你所扮演的角色: (請按參與日期順序列出最近期三項) Briefly describe your past extracurricular activities, volunteer community service experience and your responsibilities: (Please place the 3 most recent items in chronological order.) Date 日期 From To(Mo
9、nth/Year) (Month/Year)課外活動、義務工作經驗及角色 Description of the volunteer work and your responsibilities 機構 Organizer/Employer4.你曾否獲得由學術機構、非政府機構或政府機構所頒發的獎項或嘉許? (請按獲嘉許日期順序列出最近期三項) Have your ever received any honors or recognitions awarded by any academies, non-governmental organizations or government departm
10、ents? (Please place the 3 most recent items in chronological order.) 年 Year獎項/嘉許 Honor/Recognition頒發機構 Awarding Organization第三部分第三部分對實習工作的興趣對實習工作的興趣 Part 3 Your Interest in an Internship 1. 請表示你對以下工作類別的興趣，排列次序: 1=十分有興趣, 2=有興趣，3=一般。(請於適當方格中表示) Please indicate your interest in working in an internship
11、 in order with 1= Very Interested, 2= Interested, 3=No Strong Preference. (Please put a cross in the appropriate box. ) 1231=十分有興趣十分有興趣 Very Interested，2=有興趣有興趣 Interested，3=一般一般 No Strong Preference 協助機構組織及聯繫義工或社區活動，以建立伙伴合作關係 Assist in liaison work for volunteer and community activities that help s
12、trengthen partnerships between the non-profit organization and other sectors 協助機構的宣傳推廣及形象建立工作/活動 (宣傳品、片段製作、宣傳活動組織及聯繫等)，藉此提升社區人士對 該機構的認識 Assist in brand building and publicity activities for the non-profit organization (i.e. the production of promotional materials, video clips and liaison work for pr
13、omotional activities, etc.) that enhance public awareness of the organization in the community 協助機構有關籌款的傳訊工作，以及拓展捐獻者資料等 Assist in the communication of fund-raising work and the expansion of donor databases 協助機構推行環保措施 Assist in the implementation of environmental protection measures 如有其他，請簡述: Others,
14、 if any, please specify: 3 CIP-SA2. 請表示你對以下社會服務類別的興趣，排列次序: 1=十分有興趣, 2=有興趣，3=一般。(請於適當方格中表示) Please indicate your interest in community service areas in order with 1= Very Interested, 2= Interested, 3=No strong preference. (Please put a cross in the appropriate box. ) 1231=十分有興趣十分有興趣 Very Interested，2
15、=有興趣有興趣 Interested，3=一般一般 No strong preference 兒童及青少年服務 Children and Youth 長者服務 Elderly家庭及社區服務 Family and Community 復康服務 Rehabilitation 3. 請列出你最有興趣參與的 3 項實習工作編號以作內部參考，有關實習工作詳情，請參閱計劃網站 www.cip.org.hk；本會將盡量根據獲 取錄學生的工作選擇安排實習。 Please indicate 3 placement offers that are of your interest. For details, please refer to www.cip.org.hk. Upon selection, the placement of internship will be considered according to your mentioned choices. 1. 2. 3. 第四部分第四部分語言語言/其他技能其他技能 Part 4Your Language Skills / Other Information
