台湾、香港、澳门居民参加国家医师资格考试实习申请审核表

le nameР地区/Region:Р有效身份证件名称和号码/ID No: Р性别/Sex:Рmale [ ] female [ ]Р出生日期: 年月日РDate of Birth: y. m. d.Р学历/Academic Degree Obtained:Р专业/Specialty:Р毕业学校/School of Graduation:Р入学时间/Date of Entry:Р毕业时间/Date of Graduation: Р毕业证书编码/Certification No:Р通讯地址/Address:Р联系电话/Tel:РE-mail:Р申请实习机构名称/Institute of Internship:Р申请实习岗位类别/Category of Internship:Р申请实习期限:自年月至年月РDuration: From y. m. to y. m.Р接受院校Р签字盖章РAuthorized by:Р(印章/Seal)Р年月日Р申请人签字:РSignature of Applicant:Р年月日Рy. m. d.Р省级卫生/中医药行政主管部门签字盖章Р年月日Р备注Р1、此表仅限于为参加国家医师资格考试的来内地实习一年的台湾、香港、澳门人员使用。Р2、请持本表前往实习所在地市、县公安机关出入境管理部门办理相应的签注手续。РNote:Р1.This form is for ing from Tai Wan, Hong Kong and Macao who plan to take the Examinations for the Qualifications of Doctors.Р2.Please present this form to apply for entry visa at local Police Office.Р共三联第一联:寄台湾、香港、澳门实习人员