2018 ACSC Nomination and Personal Particulars Form

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2018 ACSC Nomination and Personal Particulars Form Course Name/s: 2018 DSSC

Course Dates: - 2017 IELTS Prep Cse 13 Mar – 26 May 17 - 45/17 AMF Course 30 Oct – 10 Nov 17 (DITC) - 01/17 ADC Preparation Course 13 Nov – 15 Dec 17 (DITC) - 2018 DSSC Jan – Dec 18 (ADC) Target Course: 2018 DSSC

To be returned by: 01 Feb 17

Screen Test Date IELTS-A screen testing will be conducted 0900-1200 each day at IDP Silom during the period 06-10 Feb 16. Which day are you available to attend ? On completion, the form is to be returned electronically to all addressee listed below. DCO - Khun Sawitree Jongsuwat 02 344 6386 [email protected]

PERSONAL PARTICULARS Family Name:

Given Names:

Preferred Name/Nickname:

Gender: Male Date of Birth:

Have you attended Defence sponsored No training in Australia? If so, when?

Have any of your Personal Particulars changed since your last course in N/A Australia? If so, please advise the change.

Service (Navy, Army, Air Force, Civilian): Corps:

Rank/Grade:

Military ID or Service Number:

CORRESPONDENCE Work address: Home address: Email address:

Phone numbers: Work Fax

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POSITIONS Please indicate the positions held for the past 10 years, starting at current posting Year Posting/Position (Job Held)

COURSES/QUALIFICATIONS Please indicate all local, overseas and civilian courses completed during the past 10 years Qualification Year Course Country (if applicable)

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Target Course Information

Target Course Name: 2018 DSSC

Candidate ADFELPS Profile:

Date of Test: S - L - R - W - *Note this profile is valid for only 12 months and candidates will not be retested for 3 months after test date.

Example only: Listening 13c Rater: TH 980226

Speaking Listening

Reading Writing

Name and Rank of Supervisor

Supervisor’s Signature Date:

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