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["附表1"]
["2017汕头大学医学院二附院住院医师规范化培训学员报名表"]
["姓名",null,"性别",null,"出生年月",null,"相片"]
["籍贯","  省  市","民族",null,"健康状况"]
["身份证号码",{"$nulls":3},"英语等级"]
["最高学历       （全日制）",null,"最高学历   毕业专业",null,"最高学历   毕业时间"]
["最高学历      毕业院校",null,null,"学位","研究生类别      （ √ ）","专业型 □  科学型 □"]
["是否已取得     执业资格证","是 □    否□",null,"执业类别",null,"取得执业医  资格证时间","年  月  日"]
["联系方式","手机      （中国移动）",null,"家庭电话",null,"Email"]
[null,"本人现住址",null,null,"家庭住址"]
["培训经历","既往是否参加规范化培训：是 □   否 □。已有培训经历者填写：      年    月至"]
[null,"既往是否参加规范化培训：是 □   否 □。已有培训经历者填写：      年    月至"]
[null,"师规范化培训，已完成轮转科目及轮转时间：                                "]
["申请人意见","    本人自愿参加住院医师规范化培训，遵守培训合同，并保证所提交信息的真实性，且与省规培平台信息一致。如有虚假，本人愿意承担由此引发的一切后果。                                                                                                                                                 \n                                                                                                                                                                                                                                                                                                                                                                           \n                           本人签名：            年   月   日                                                                                                                                                                                                   \n                                                                                                                                                                                                                                                                                                      "]
["报考信息栏"]
["学员类别","专业基地名称",null,"专业基地代码",null,"单位名称"]
["本单位学员",{"$nulls":4},"汕头大学医学院第二附属医院"]
["社会学员","1、",{"$nulls":3},"注：按志愿顺序依次录取。\n2为调剂志愿，不服从调剂者请勿填写。"]
[null,"2、"]
["委托培养学员",{"$nulls":4},"委培协议单位："]
[]
[null,"委培单位意见：\n\n单位负责人签名（公章）：",{"$nulls":3},"单位联系人姓名：\n\n单位联系电话："]