Application Form (Please Type Or Print)

附件 2： Application Form (please type or print) The country (name of nominating organization/ institution/ Country) Nominates: （name of applicant） To the Training Workshop on Water Resources Management for ACD Countries, Hubei/Beijing, China, November, 2017

Reasons for nomination (mandatory):

Signature of nomination organization/institution/company

(if necessary/ applicable) The nomination is approved by (name of authorizing authority): In accordance with local rules. Date Signature of authorizing authority

The application MUST be submitted to the International Economic &Technical Cooperation and Exchange Center, Ministry of Water Resources no later than September 30, 2017.

Mailing Address: The International Economic &Technical Cooperation and Exchange Center, MWR Jiye Building, No. 10, Nanxiange Avenue, Xicheng District, Beijing, China 100053 Liaison: Ms. FAN Yanfang/Ms. ZHANG Xin Tel: +86 10-63202012, +86 10-63202362 Fax: +86 10-63202274 Email: [email protected] , [email protected]

1 PERSONAL HISTORY First name: Date of birth: (yy-mm-dd) Second name: Passport No.: Family name: Telephone: (surname) (office) Sex(M/F) Mobile: Country: Fax: Nationality: E-mail(s): Office address: Name of person to be notified in case of an emergency: Full name: Telephone: Email: Education: Name of institution Major fields of Years of study Degree obtained (university) and place of study from-to study

Previous residence in foreign countries in relation to applicant’s professional or study interest: EMPLOYMENT RECORD A.PRESENT POSITION Title of your post: Years of service: from-to From to Type of organization Name of Supervisor: (if any) Name and Address of Employer: Description of your work, including your personal responsibilities:

B. PREVIOUS POSITION Title of your post: Years of service: from-to From to Type of organization Name of Supervisor: (if any) Name and Address of Employer: Description of your work, including your personal responsibilities:

3 QUESTIONNAIRE Please briefly state your reason for applying to this training workshop, your main field of interest within the workshop and your expected benefit from the workshop:

Describe your work duties in relation to flood management and control/water-saving irrigation technology:

4 PROJECT INVOLVED Short description of the project involved in relation to flood management and control/water- saving irrigation technology:

5 LANGUAGE CAPACITY English certification does not have to be carried out if any of the following is applicable: □English is my primary language or official language of my country of residence □English is my working language(please enclose statement from management) □Attended a higher education institute (min 6 months) where English was the primary language used (please enclose copy of certificate) ABILITY TO UNDERSTAND ABILITY TO SPEAK □Understands without difficulty when addressed at □Speaks fluently and accurately and is easily normal rate intelligible □Understands almost everything, if addressed slowly □Speaks intelligibly, but is not fluent or altogether and carefully accurate □Requires frequent repletion and/or translation of □Speaks haltingly, and is often at a loss for words or words and phrases phrases ABILITY TO WRITE READING ABILITY AND COMPREHENSION □Writes with ease and accuracy □Reads fluently, with full comprehension □Writes slowly and with only a moderate degree of □Reads slowly, but understands almost everything accuracy □Reads with difficulty, and only with frequent □Writes with difficulty and makes frequent mistakes recourse to a dictionary

MEDICAL STATEMENT Please check the relevant boxes □I do not have any infectious diseases (for example tuberculosis or trachoma) or any other illnesses which could present risks to persons that I will come in contact with □I do not have any medical conditions which prevent me from carrying out training away from home □I am in good health and enjoying full working capacity Comments

CULTURE AND DIETARY HABITS (Please write down your habits of culture and dietary) Taboo:

Dietary: □Halal □Chinese food □Western □Vegetables Other habits:

Information to all applications: Upon confirmation that your application has been accepted, the personal information that you have given in this application will be used by the workshop organizer in administering the workshop. The data will not be used for other purposes. Signature of Applicant I certify that my answer to the foregoing questions are true, complete and correct to the best of my knowledge. If selected as a participant I pledge to spend the time during the period of the workshop as directed by the workshop management.

Date: Signature of Applicant: