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["中山大学附属口腔医院住院医师规范化培训学员报名申请表"]
["申请培训的专业基地名称：                    申请培训的专业基地代码：        "]
["姓名",null,"性别",null,"出生日期",null,"籍贯"]
["民族",null,"身高（CM)",null,"政治面貌",null,"婚姻状况"]
["身份证号码",{"$nulls":3},"计算机等级",null,"外语等级"]
["医师资格证","□有   □无",null,"证书编号"]
["健康状况",null,"薪金要求",null,"联系方式","Email："]
["专业技术职称",{"$nulls":4},"手机："]
["特长",{"$nulls":4},"紧急联系人："]
["现实习/工作单位",{"$nulls":4},"紧急联系人及手机："]
["通讯地址及邮编"]
["高等教育\n\n学习经历","起止时间",null,"学历","学位","学位类型","专业","导师"]
[]
[null,"学历证书编号：",{"$nulls":3},"学位证书编号："]
[null,"起止时间",null,"学历","学位","学位类型","专业","导师"]
[]
[null,"学历证书编号：",{"$nulls":3},"学位证书编号："]
[null,"起止时间",null,"学历","学位","学位类型","专业","导师"]
[]
[null,"学历证书编号：",{"$nulls":3},"学位证书编号："]
["实习及工作经历"," 起止时间",null,"单位",null,"实习/工作","具体负责工作"]
[]
[]
[]
["其他需要说明的问题:"]
["是否服从基地调剂安排:             □是       □否"]
["本人承诺：以上所填写的内容全部属实，并愿为内容的真实性负责。 \n\n                                             亲笔签名：           日期："]
[]
["申请截止日期：2017年4月15日"]

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