zilongwang/ReadingBank huggingface dataset:
If additional space is needed, please continue on a separate page using the same format. a. Name & degree b. Place of employment REMINDER: is required for NYC H + H, KC c. Will this person be obtaining verbal or written Informed Consent/Authorization d. Does the clinician have or declare a Conflict of Interest (COI), including the participation in the product design or development of this device, or as a company directory or consultant? If yes, submit COI disclosures. SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No SUNY Downstate NYC H + H, KC Other: Yes No Yes No
L) Consultation & Referees In determining your grant application it may be necessary to consult with others. Are there any Town or Flintshire County Councillors and / or Officers that are familiar with or involved with your organisation? (Please indicate whether familiar or involved) Name Familiar Involved in what capacity M) Declaration I confirm on behalf of the organisation that the information contained in this application is true and correct and has been approved by the management committee. I understand that any grant awarded by the Council will be subject to terms and conditions and will only be used for the purpose described in this application. Please Note: This section MUST be signed by both the Applicant AND a Member of the Management Committee. Applicants Name Position on management committee (if applicable): Signature: …………………………………………….. Date: Management Committee Members Name (PRINT): Position on Management Committee: Signature: …………………………………………….. Date: out this form. Sign it. Post it (with the necessary documents) to: Mr Alan Thorniley, Town Clerk Saltney Town Council 49 Meadowsway CH2 1HZ Data Protection Disclaimer Statement Any data supplied by you will be processed in accordance with Data Protection Act requirements and in supplying it you consent to the Council processing the data for the purpose for which it is supplied. All personal information provided will be treated in the strictest confidence and will only be used by the Council or disclosed to others for a purpose permitted by law.
Patient Educator Group application form Mr / Mrs / Ms / Miss / Dr / Other (please specify) Name: Address: address: number: Home Mobile Date of Birth: Gender: Ethnicity: Mobility issues and/or sensory impairment (if yes do you require any aids – please state): Do you have a condition that requires the use of oxygen: Yes No Dietary requirements (please state): Preferred method of transport? Own Public Taxi Patients (please complete if you would like to be involved as a patient) Medical condition: (please detail any long term health conditions or disabilities that you wish to be involved in teaching sessions for) Will you be accompanied on the day eg by a partner or carer? Yes No Carers (please complete if you would like to be involved as a carer) Relationship to the person you care for: What is their date of birth? What is their medical condition? Teaching sessions I am interested in (please circle appropriate answer) History taking/Patient experience (a student will take your medical history and explore the impact your illness has on you and your family; or a question and answer session with a small group of students) Yes No Maybe Physical examination (a simple physical examination based on your condition, students will be supervised at all times) Yes No Maybe Yes No Maybe
Student assessment (helping to assess students under exam conditions, a mixture of history taking and physical examination) Committee (helping to shape the involvement of patients in BSMS teaching, assessment and admissions) Yes No Maybe Admissions interviewing (being involved in interviews to assess potential candidates to see if they are suitable to study medicine at BSMS) Yes No Maybe Widening Participation activities for young people (for example BrightMed/BrightIdeas Scheme). These provide learning opportunities for 16-19 year olds who have expressed an interest in studying medicine Yes No Maybe Availability: (teaching sessions are usually Monday to Friday 9am – 5pm) Any other relevant information you would like the teaching session lead to know (including any relevant allergies): Please sign and date to confirm you wish to join the Patient Educator programme at Brighton and Sussex Medical School Signature: Date: Patient Educator Programme: General Consent Form Taking Part in Medical Student Teaching Sessions. Please tick each statement to show you understand then sign at the bottom of the form. I understand that: I have volunteered to take part in a teaching session for medical students at the Brighton and Sussex Medical School. Medical students, under the supervision of fully qualified staff, ask about and record details of my medical condition. Medical students, under the supervision of fully qualified staff, might conduct a physical examination. This will not include any intimate examination or any physical examination that I do not wish to have. I have volunteered to take part in Widening Participation schemes for young people, which is part of BSMS activities.
APPLICATION FOR EMPLOYMENT Position applied for Location Vacancy/Reference No. Teacher – Permanent Full time Epuni Care and Protection Residence Lower Hutt E2018/01 Tick One Mr Mrs Ms Miss Or other preferred title: Surname/Family name First names (in full) Are you known by any other name(s)? (if yes please provide below) Yes No Maiden Name (if applicable): Full postal address Email address Contact telephone numbers Private: Business: Please tick the appropriate boxes: Proof of identity and right to work check
University Other Employment History Please list your work experience in your last five positions beginning with your most recent position held. If you were self-employed, give details. If you have had more than five positions in the last five years, please list them all. Attach additional sheets if necessary. Period worked (please specify the length of service) Employer’s name Position held Reason for leaving Referees Please provide the names of three people who could act as referees for you. At least one of these should be able to attest to your most recent work performance (please indicate in the table below). If you have included written references from people other than those recorded below, please note that we may contact the writers of these references. Name Contact details (organisation and address) Phone (landline preferred) Relationship Authority to approach other referees
Authority to approach other referees I authorise the Board, or nominated representative, to approach persons other than the referees whose names I have supplied, to gather information related to my suitability for appointment to the position. Yes No I authorise the Board, or nominated representative, permission to access any information held by the Education Council of Aotearoa New Zealand (EDUCANZ) or any other educational organisation, including matters under investigation, to gather information related to my suitability for appointment to the position. SIGNED: DATE: Yes No The position you have applied for requires specific knowledge, skills, attributes (Essential criteria) and personal characteristics. These are stated in the person specifications section of the position description. Please outline below how you meet each of these attributes and abilities. Even though you are attaching a C.V, please fill this out in full. The contact person cited in the advertisement can assist with any of the questions you may have. Essential Criteria (Knowledge, skills, attributes and personal characteristics) Past roles in which you have demonstrated this knowledge, skills, attributes and personal characteristics What did you do which demonstrated this? Key achievements Teach effectively across the curriculum Curriculum strengths Collaborative practice Cultural competency Learners with diverse and complex needs Working as part of a team Individual plans Personal and professional attributes
OTHER RELEVANT EXPERIENCE Include details of voluntary work, projects undertaken, study, membership or organisations etc. COMMENTARY Please your reasons for applying for this job. Referring to the Person Specification, please use this section to explain how your skills, experience and qualities enable you to meet the requirements of this post. Please use continuation pages, if required, and head appropriately.
1. Overview The Community Investment Fund dedicated to the Marulan and surrounding communities is designed to help improve the quality of life of the members of our workforce, their families and the communities. We value local needs, promote community involvement and partner with local stakeholders around our operations. Holcim has dedicated funding and co-contributions to improve economic, cultural and social development throughout the region. In addition as a part of the community we encourage and support our employees’ engagement in volunteering and local community work. 2. Contact If you have any questions regarding the fund, please contact the Environment and Community Liaison on 1300 657 051 or 3. Funding Application Form Project Contact Details Primary Contact Name: ________________________________ Position:_______________________________ Phone:________________________________ Fax:__________________________________ Email:_________________________________ Address:_______________________________ Secondary Contact Name: ________________________________ Position:_______________________________ Fax:__________________________________ Address:_______________________________
Secondary Education and Qualifications Name of school/college From To Qualifications gained with date Higher Education Name and address of university, college and/or university education department Dates Full or part-time Courses/subjects taken and passed Date of examination and qualifications obtained Age groups for which trained From To
Sexual orientation Please tick Bi-sexual Gay Man Gay Woman Heterosexual Other Prefer not to say Gender Please tick Female Male Transgender Prefer not to say Personal relationship Please tick Single Living together Married Civil Partnership Prefer not to say Religion or belief Please tick No religion Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim Sikh Any other religion (Write in) Prefer not to say Disability Do you consider that you have a disability? Please tick Yes - Please complete the grid below No Prefer not to say My disability is: Physical Impairment Sensory Impairment Mental Health Condition Learning Disability/ Difficulty Long standing illness Other Prefer not to say
Title First Name Surname Position applied for Gender Male Female Date of birth Nationality Marital status Married / civil partnered Single Divorced Legally separated Widowed Religion or belief Buddhist Christian Hindu Jewish Muslim Sikh Some other religion or belief No religious belief Prefer not to say Page of Ethnic origin (Census 2001 Ethnicity Categories) White – British White – Irish Other White Background Black or Black British – Caribbean Black or Black British – African Other Black background Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Chinese Other Asian background Mixed – White and Black Caribbean Mixed – White and Black African Mixed – White and Asian Other Mixed background Other Ethnic background Prefer not to say Sexual orientation Heterosexual Gay / lesbian Bisexual Other Prefer not to say
custody sentence of over 6 months but not more than 2 ½ years Imprisonment or youth custody sentence of less than 6 months 7 years * Fine or other sentence for which the Act does not specify a different rehabilitation period 5 years * Absolute discharge 6 months * Borstal 7 years * Detention Centre 3 years * Probation order, conditional discharge or bound over 1 year or until the order expires, whichever is the longer Care order or supervision order 1 year or until the order expires, whichever is the longer for custody in a remand home, approved school or an attendance centre order 1 year after order expires A hospital order (with or without a restriction order) 5 years or 2 years after the order expires whichever
Educational Information A. University or other Third Level Name of Institution Years Attended From To Qualification Obtained Class of Honours Main Course(s) Of Study B. Second Level (from age 14 years) Name of School Years Attended From To Certificate or Diploma Obtained Subjects Grade & Level
Name and Address Main duties Responsible to Reason for leaving GAPS IN EMPLOYMENT Please account for any gaps in employment: FROM TO REASON LEISURE INTEREST AND HOBBIES HEALTH Please note that the successful applicant will be required to complete a Health Questionnaire and make a declaration that he/she is medically fit for the post. If necessary he/she may be asked to undergo a medical examination.
13. Please specify the milestones and key deliverables for your proposal in the table provided Please note that the milestones entered here may form part of your monitoring if you are successful. Milestone March to June 2017 July to Sept 2017 Oct to Dec 2017 Jan to Mar 2018 Apr to Jun 2018 [insert milestone] [insert milestone] [insert milestone] [insert milestone] [insert milestone] [insert milestone] Milestone July to Sept 2018 Oct to Dec 2018 Jan to Mar 2019 Apr to Jun 2019 [insert milestone] [insert milestone] [insert milestone] [insert milestone] [insert milestone] [insert milestone]
16. Please complete the table below to show your organisation’s recent financial track record for the last two financial years for which you have audited accounts, and management figures for the current year to date. Annual accounts 2014 – 2015 Annual accounts 2015 - 2016 Management figures YTD Projected full year figures Total Income Total expenditure Surplus/deficit Current assets Current liabilities assets Term liabilities Unrestricted funds Restricted funds Total funds
Kinosaki International Arts program 2019-2020 Application Form Application date /DD Attach a portrait photo here. Name of applicant Group name (if applicable) Name of representative Representative’s date of birth Representative’s nationality Address TEL FAX E-mail Website Genre circle relevant genre (multiple choices allowed) Representative’s background Year / Month Indicate educational background, earned degrees, artistic background, significant works and activities, awards won, etc. / / / / / / / / / / Artist statement and self-introduction (about 200 words)
C British  Indian  Pakistani  Bangladeshi  Chinese  Any Asian background (write in) D Black/African/Caribbean/Black British  African  Pakistani  Caribbean  Any other Black/African/Caribbean background (write in) E Other ethnic group  Arab  Any other Black/African/Caribbean background (write in) Sexual orientation  Heterosexual  Gay / lesbian  Bisexual  Other Disability  No known disability  Specific learning disability (such as dyslexia or dyspraxia)  General learning disability (such as Down's syndrome)  Cognitive impairment (such as autistic spectrum disorder or resulting from head injury)  Long-standing illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)  Mental health condition (such as depression or schizophrenia)  Physical impairment or mobility issues (such as difficulty using arms or using a wheelchair or crutches)  Deaf or serious hearing impairment
4 Broomhall Road, Sheffield S10 2DN Tel: 0114 2721453 Email: info@broomhallunder3s.co.uk First Name(s): Surname: Date of Boy Girl Address: Postcode: 2. Parent/Carer Details Parent/Carer 1 Parent/Carer 2 Title e.g. Mr/Mrs/Ms/Miss/Dr First & Second Name Date of Birth Address If different from child Home Telephone Mobile Telephone Work Telephone Email Relationship to child Has Parental Responsibility Yes No Yes No NI Number Other family members/adults at child’s address Name Relationship to child Name Relationship to child Name Relationship to Name Relationship to child Other significant adults/frequent visitors who regularly visit the home or who are part of the family support network. Name Relationship to child Telephone contact Name Relationship to child Telephone contact People (over the age of 16) with permission to collect your child from nursery. Name Relationship to child Telephone contact Name Relationship to child Telephone contact Are any special circumstances or information that we should know about in order to help and support you and your child e.g. family situations, restrictions on collecting, etc? 3. Sessions Requested
∙ Position Information 2016 Korea Tourism Organization Recruitment [Section] Select one of the following two positions (Multiple selection not allowed) Full-time > Translator/Editor (English/Online Marketing) Full-time > Translator/Editor (English/Publication) [Employment Status] Indefinite Duration Employment Contracts *After probation period of three months ∙ Applicant’s General Information photo Name [Last] [Given] Date of Birth (yyddmm format) Current Address Alien Registration Number Mobile Number E-mail Foreigner Status [Nationality] [Visa Status] ∙ Educational Background Level School Name Period Location Status (enrolled/temporary withdraw/ graduated/soon to graduate ∙ Job Related Training (Provide details on subject, completion date, validity, etc.)
<Application Notices> ○ Applicant must provide documentary evidence to confirm the credibility of the information in the application. Unsupported information will not be considered. ○ Providing false information, forged documents, or cheating on the examination will result in immediate disqualification. Those who have been offered the position will have their contract revoked. Applicant will be banned from applying to the organization for five years after the event. ○ Applicant will take responsibility for any disadvantage incurred from incorrect information and/or missing documents. ○ In the case of no qualified candidates being found in the admission process, it is possible for no applicants to be selected. ○ Acceptance can be rescinded in the case of applicant failing the medical examination and background (Certificate of Criminal Record Check included). ○ Applying for work must be allowed on current visa status. ○ The details of aforementioned recruitment may change based on circumstances of the company; see the official Korea Tourism Organization website (http://kto.visitkorea.or.kr) for further notices. <Required Documents> (All applicants) One copy of Alien Registration Card. (Valid applicants) One copy of graduate diploma, proof of employment certificate, and qualification certificate each. A signed and scanned copy of the "Agreement for Collection and Use of Personal must be sumbitted with your application.
advancement of promotions while you worked at this company Employment Status Contract Permanent Salary Reason for Leaving Company Name Address Phone Number Position Year, from-to Number of subordinate(s) Supervisor name List Your duties performed, skills used or learned, advancement of promotions while you worked at this company Employment Status Contract Permanent Salary Reason for Leaving
Please clearly describe the research plan and its relationship with the invitee, and mention its (inter-)national impact, benefits for Nagoya University, and contributions to the development of academic research in Japan. the Symposium and Exchange Please describe the international symposium which will be held during the invitation period
Sl. No. In the Capacity of Period Organised at Sponsored by National / International From To Length of service over and above the relevant minimum teaching experience required for a given cadre [Max 10 Credit Points since last promotion] Sl. No. Current cadre Experience in Current Over and above teaching experience Establishment of New Lab(s) [4 Credit points since last promotion] Sl. No. Name of Lab Year of Establishment Department/Institute Theory Teaching of over and above 6 credit hrs course [Max 6 Credit Points since last promotion] Sl. No. Name of the Course Total teaching hours per week Year and Semester PG Dissertation Guided [Max 10 Credit Points since last promotion] Sl. No. Title of Dissertation/Project Department/ Institute Name of student[s] Co- Supervisor[s], if any Year UG Projects [Max 4 Credit Points last promotion] Sl. No. of Dissertation/Project Department/ Institute Name of student[s] Co- Supervisor[s], if any Year Text/Reference Published on relevant subjects from reputed international publishers [Max 18 Credit Points since last promotion] Sl. No. Author(s) Year of Publication Book Title ISBN/ISSN No. Publisher Text/Reference Published on relevant subjects from reputed national publishers or book chapters in the book published by reputed International publishers [Max 6 Credit Points since last promotion] Sl. No. Author(s) Year of Publication Book Title Title of Chapter, Page No. (if any)
Supervision Overview Basel Banking Core Principles Insurance IAIS Core Principles Risk-Based Supervision Frameworks Consolidated Supervision Concepts Supervisory Activities (Planning, Offsite, Onsite, Reporting, and Follow Up) Intervention Strategies and Ladders of Intervention Supervision – Oversight Activities Corporate Governance Assessing Board and Senior Management Assessing Risk Management Assessing External Audit Assessing Internal Audit Assessing Actuarial function Assessing Compliance Supervision – Business Activities Understanding Banking Business Activities and Associated Risks Understanding Insurance Business Activities and Associated Risks Identifying Significant Activities and Businesses Inherent Credit Risk Inherent Market Risk Liquidity and ILAAP Operational Risk Capital and II Basel III Structural Interest Rate Risk Soft Skills Interviewing Institution Management Management Letter and Recommendations Closing Meetings with CEO Meetings with Boards and Committees Action Planning Stakeholder Communications Crisis Management Crisis Binder Preparation Crisis Preparedness Simulation Desktop Crisis Simulation Computer-Based Crisis Simulation Stakeholder Communications Crisis Resolution Mechanisms Emerging Risk Identification Emerging Risk Identification Linking Macroprudential and Economic Indicators to Supervisory Work Stress Testing Consolidated Supervision Accounting Concepts Capital Analysis Consolidated and Unconsolidated Cooperation Dealing with Non-Regulated Entities in a Group or a Non-Regulated Holding Company Other (List):
EDUCATION AND QUALIFICATIONS (Including any relevant professional qualifications) SCHOOL, COLLEGE, UNIVERSITY Dates Dates COURSES & EXAMINATIONS TAKEN WITH RESULTS MEMBERSHIP OF PROFESSIONAL ASSOCIATIONS Please list the professional bodies of which you are a member, together with the level and date of membership. FURTHER PROFESSIONAL DEVELOPMENT Please provide details of any professional development undertaken.
APPLICATION FOR RESIT (WRITTEN EXAMINATIONS ONLY) TO BE HELD IN BRITISH COUNCIL OFFICES OVERSEAS Form to be completed by the student: Surname (Family name) First Name Student ID Number Course Modules resitting (confirm codes and titles if known) International home telephone number International mobile telephone number Email address Test city location in which examinations are to be taken If you have taken resit examinations overseas prior to this application, please confirm where and when this/these took place Resit Period Semester Application Deadline Request Resit YES/NO January 1 19/11/2018 May/June 2 08/03/2019 August 1 & 2 08/07/2019 Please return this form by the necessary deadline (as described above) to Applications received after this may not be processed.
Evidence of residency (Art 68 subsection 2) This be either a copy of the National Identity card / passport (for Rwandese nationals) or VISA / work permit or official immigration status documents (for non-Rwandese Nationals) of payment (attach bank deposit slip(s) of appropriate fees in accordance with (Art 68 subsection 3) (Annual membership fee is Frw 200,000 while practicing certificate fee is Frw 200,000 per year. All fees are payable to ICPAR bank account. The bank account details are; Institute of Certified Public Accountants of Rwanda, Ecobank Rwanda SA, Avenue de la Paix (a/c 110-44131-01-72). Copy of Tax Registration Certificate ( TIN Number) (Art 68 Subsection 5) Note : Applicants who are involved in Public Practice must provide evidence of the same in the form of a letter from the organization they work for / letter of admission to partnership / official registration documents that provide sufficient evidence that they are in Public Practice. For all applicants who are NOT already involved in Public Practice In addition to providing the information requested for in section C (i) above, applicants who are NOT already in Public Practice, should provide the information requested for in this section C (ii) :- Evidence of prior practical experience of two (2) years in a position of responsibility to manage audits or accounting assignments (Art 68 subsection 4) (attach detailed CV certified on each page by a Certified Public Accountant) Recommendation from a Certified Public Accountant who confirms having supervised you and is convinced of your proven experience and competence in independent auditing. (Art 68 subsection 4)
de-identified data only, Specimen shipment, etc. INVESTIGATOR FOR COI PURPOSES. SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to c. of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier?
TABLE OF STUDY STAFF For training and conflict of interest disclosure requirements see: a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. Place of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No
a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. Place of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No
TABLE OF STUDY STAFF For training and conflict of interest disclosure requirements see: a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. Place of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No
a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No
If additional space is needed, please continue on a separate page using the same format. a. Name & degree b. Place of employment c. Will this person be obtaining verbal or written Informed Consent/Authorization SUNY Downstate NYC H+H, County Other: Yes No SUNY Downstate NYC H+H, County Other: Yes No SUNY Downstate NYC H+H, Kings County Other: Yes No SUNY Downstate NYC H+H, Kings County Yes No SUNY Downstate NYC H+H, Kings County Other: Yes No SUNY Downstate NYC H+H, Kings County Yes No SUNY Downstate NYC H+H, Kings County Other: Yes No SUNY Downstate NYC H+H, Kings County Other: Yes No Attach additional if needed.
If additional space is needed, please continue on a separate page using the same format. a. Name & degree b. Place of employment c. Will this person be obtaining verbal or written Informed Consent/Authorization SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No SUNY Downstate KCHC Other: Yes No Attach additional pages if needed.
WAIVER OF INFORMED CONSENT REQUIREMENTS IRB Number: Project Title: Principal Investigator: Please the applicable category of waiver(s) requested: Waiver of Informed Consent (waiver of the entire process of informed consent) -complete Section 1. Waiver of Required Elements of Informed Consent - complete Section 1 & 2. Waiver of Documentation of Informed Consent (waiver of signatures) -complete Section 3. Section 1: If there is more than one study population (or groups/study arms) in the study, please describe the population(s) (or groups/study arms) for which this wavier pertains: N/A – applies to all research participants. Describe why the research cannot practicably be carried out without the waiver: Please check either box 1 or box 2 below: (1) The following criteria are met: The research involves no more than minimal risk to the research participants; The research could not practicably be carried out without the requested waiver or alteration; If the research is federally supported or conducted and involves the use of identifiable private information or identifiable biospecimens, the research could not practicably be carried out without using such information or biospecimens in an identifiable format; The waiver or alteration will not adversely affect the rights and welfare of the participants; Whenever appropriate, the research participants or LARs will be provided with additional pertinent information participation (e.g., debriefing research participants involved in deception research). If box (1) is checked, when applicable, describe how the research participants will be provided with additional pertinent information participation: N/A (2) The research cannot practicably be carried out without the waiver or alteration and the research or demonstration project is to be conducted by or subject to the approval of state or local government officials and is designed to study, evaluate, or otherwise examine: public benefit or service programs; procedures for obtaining benefits or services under those programs; possible changes in or alternatives to those programs or procedures; or possible changes in methods or levels of payment for benefits or services under those programs Section 2: If there is more than one study population (or groups/study arms) in the study, please describe the population(s) (or groups/study arms) for which this wavier pertains: N/A – applies to all research participants.
HIGHER EDUCATION:- D2 University or College and/or University Education Department (please provide addresses) FT/ PT Dates From To Year Month Year QUALIFICATIONS OBTAINED:- Qualification Obtained Date Passed Subjects passed (with details of standard obtained) Age groups for which trained Please continue on a separate if necessary.
PROFESSIONAL COURSES OBTAINED:- (OTHER THAN THOSE DETAILED IN D2a OVER THE PAST THREE YEARS) D3 Subject Date Achieved (Approx.) Organising Body Duration E Previous employment We require a full employment record with any gaps in employment explained in writing. Please commence with the most recent employer. Please list all previous employment, since the age of 18, in chronological order. Include full-time (FT) or part-time (PT) work and any unremunerated activity e.g. unpaid voluntary work. E1 Employer’s name Employer’s address Job title Employment Status Number on roll (if school) Salary Date started DD / MM / YY Date finished DD / MM / YY Reason for leaving
C. EMPLOYMENT RECORD Teaching Experience please begin with your present, or more recent employment: please explain any gaps in Service: NAME & ADDRESS OF SCHOOL Date CONTRACT TYPE PWT/TWT/ PRPT/ Part-time If Pro-rata hrs per week Subjects Taught Level From To Non Teaching Experience Dates (From/To) Name & Address of Employer Position Held Summary of Main Duties D. SUPPORTING STATEMENT
CADD 140 4 Basic AutoCAD (F W Sp Su) Surv 125 3 Introduction to GIS (F) Surv 202 4 Boundary Surveying (F) 16 Winter Quarter  Course # Credits Title Surv 223 3 Boundary Law I (W) Surv 250 3 ArcGIS I (W) Phsc 5 General Physical Science (F W Sp) Cmst& 210 5 Interpersonal Communication (F W Sp Su) 16 Spring Quarter  Course # Credits Title CADD 143 4 Civil Drafting with AutoCAD (Sp) Surv 264 3 Survey Software Applications (Sp) Surv 203 3 Legal Descriptions (Sp) Surv 225 3 Subdivision Planning & Platting (Sp) Btec 169 3 Introduction to Excel (F W Sp) 16 Total Credits 98 Associate in Applied Science * 104, 110 are also acceptable Course Descriptions INTRODUCTION TO GPS SURV 100 2 Credits 11 hours of lecture - 22 hours of lab
From: To: Employer’s Name & Address: Job Title: Salary: Notice period required: Description of Duties: From: To: Employer’s Name & Address: Job Title: Description of Duties: From: To: Employer’s Name & Address: Job Title: Description of Duties: From: To: Employer’s Name & Address: Job Title:
Briefly describe the setting and your experience (approximately 100 words): Supervisor: Supervisor Phone: Supervisor Facility Name: Facility City/State: Job Dates: to Per Week: Briefly describe the setting and your experience (approximately 100 words): Supervisor: Supervisor Phone: Supervisor Email: Facility Name: Facility City/State: Job Title: Dates: to Hours Per Week: Briefly describe the setting and your experience (approximately 100 words): Supervisor: Supervisor Phone: Supervisor Email: Please attach additional pages as necessary SHORT ANSWER QUESTIONS Why are you interested in an internship at UC Davis Children’s Hospital? What is your definition of music therapy? What is your music therapy philosophy? List any special therapy projects you’ve completed during your academic training.
Essential Criteria 5: A willingness to contribute to the extra-curricular life of the school. (Maximum 150 words) Desirable Criteria (Desirable criteria may be used in the final selection for shortlisting purposes.) Please indicate below to what extent you have met the following Desirable Criteria Desirable Criteria 1: Have taught GCSE Double Science for at least a period of one year of continuous employment with full class responsibility. (Maximum 250 words) Additional Qualifications and Experience Please indicate additional Qualifications not already noted above. Degrees, Diploma, Certificates, etc. University or Awarding Body Year of Award Subjects Studied Degree classification Additional Teaching Experience: Please indicate additional Teaching Experience not already noted above. Name & address of School/College Date of Appointment Date of Leaving Subjects & Levels Taught References: Please give name, address and telephone number and email address of two persons willing to give references, both of whom should be able to comment on your current professional work as a teacher. Prior consent must be obtained from referees. Please do not submit references
Please give details and dates of other significant courses completed (including In-Service) Please indicate to what extent you have met the following Essential and Additional Criteria and use size 12 fonts for your responses. Essential Criteria Qualifications Essential Criteria 1: Be a qualified teacher and registered with the as of September 2017. Yes Date Qualified Essential Criteria 2: Have an honours degree with a minimum of 2:2 classification in Mathematics is the main component or a relevant postgraduate qualification in Mathematics. * Degrees, Diploma, Certificates, etc. University or Awarding Body Year of Award Subjects Studied Degree classification Essential Criteria Experience Please outline how you fulfil the relevant criteria. Essential Criteria 3: Have taught CCEA GCSE Mathematics for at least a period of two years with full class responsibility. (Maximum 150 words)
Responsible to: Centre Manager Successful applicants will be expected to seek membership of the PVG scheme. Person Specification Criteria Essential Desirable Knowledge & Understanding A feminist analysis of sexual violence. Understanding of the impact of rape and sexual Experience At least 1 year of Voluntary or paid experience. Skills & Abilities Excellent communication skills. Capable of using own initiative and of meeting tight deadlines. Excellent organisational skills. Skilled in use of IT e.g. for case notes, email, internet searches. Monitoring, data analysis, and evaluation skills.
APPLICATION PACKAGE Department of the Interior Fish and Wildlife Service Application to Participate in the Electronic Federal Duck Stamp Program Program to Begin September 1, 2016 Application Deadline – April 8, 2016 TABLE OF CONTENTS SECTION 1 – BACKGROUND SECTION 2 - INSTRUCTIONS APPLICATION SUBMISSION AND CONDITIONS SAMPLE TRANSMITTAL LETTER DRAFT MEMORANDUM OF UNDERSTANDING SECTION 3 - EVALUATION METHODOLOGY MINIMUM REQUIREMENTS SELECTION OF THE BEST APPLICANT SELECTION CRITERIA
THE 4TH INTERNATIONAL EXPERIMENTAL THEATRE FESTIVAL, HANOI- 2019 APPLICATION FORM Name of theater group or individual: Nationality: Address, phone number, email, website: Title of the production/play: Length of play: Year of production: Number of participants: Theater / stage / special requirements for the play: Link to full video of the performance (for preview): introduction of the group, the play, the director and participating artists: Note: A link to full video of the performance must be provided to VSAA for preview. For international audiences and artists to easily understand your plays and due to limited technical conditions, we encourage plays with as little verbal dialogues as possible. In any case, we will need the dialogue transcription of you play in English.
of Maryland Department of Aging Continuing Care Application for Renewal Certificate of Registration Fiscal Year End Date: Date Submitted: COMAR Title 32.02.01.13 fully states requirements for information to be submitted when applying for a Renewal Certificate of Registration. 1. Name of Community: Chief Executive Officer: Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: 2. Executive Director or Manager: Street Address (mailing): City/State/Zip Code: Telephone Number: Address: 3. Financial Officer: Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: 4. Resident Association President Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: 5. Name of any affiliate, parent or subsidiary Person as defined in Title 10-401 (G) and (Q): Street Address (mailing):
Details of Advertisement Applications are invited for the post of ‘Research project Assistant’ for the Project entitles “Rome Foundation Global Survey of the Epidemiology of the Functional Gastrointestinal Disorsers”under the supervision of Professor Uday C Ghoshal, Department of Gastroenterology SGPGIMS, Lucknow. For details please log on to , , and send all document with CV to giphysiology@gmail.com. Name of the post No. of the post Qualification Senior Project Associate 1 M.Sc. in Sciences/ M.A. in English with knowledge of computer proficiency Research Project Assistant 1 B.Sc. in Science with experience in related field Applicants with above mentioned qualification may directly come for a walk in interview and date will be communicated later by email/phone. No TA/DA will be paid for the interview. Principle Investigator (Prof. Uday C Ghoshal) Dept. of Gastroenterology SGPGIMS, Lucknow.
(schedule) e.g. 1st June – 10th June,2017 (10 days) (Purpose) TOTAL Budget (For Year 2, if requested) Items requested Travel + Living allowance Pakistan Side French Side Requested Approved Requested Approved (name) XYZ (schedule) e.g. 1st June – 10th June,2017 (10 days) (Purpose) 3.k Budget (For Year 3, if requested)
ID MDC Ref Address Ward Planning Officer Type 97 2015/1086/HSE 132 Rodden Road Frome Somerset BA11 2AW Berkley Down Ms HANNAH PIERCE Removal of existing single storey rear lean-to. New single storey rear extension to existing brick built terraced house. Lorna Elstob Householder 98 2015/1087/VRC 8 Bath Road Frome Somerset BA11 2HD College Mr Don Morris Application for the variation of condition 15 (deliveries and collections) of planning permission 2013/1514 to allow for newspaper drop-off. James U'Dell Variation or Removal of Conditions 99 2015/1122/HSE Alwyn House 18 Georgian Court Market Mr Michael A Cooper Installation of metallic antenna/dish Lorna Elstob Listed Building Consent
Frome BA11 4BB on the side elevation. 100 2015/1068/FUL 18 Keyford Somerset BA11 1JN Keyford Mr John Whelan The construction of 2 no. 2 storey dwellings with associated parking and access. James U'Dell Full Application 101 2015/1183/TPO 21 Wallbridge Frome BA11 1QZ Keyford Mr Proposed pruning of a Cedar tree subject to Tree Preservation Order M260 - remove major deadwood, prune back 1 metre from property and industrial unit, slight lift over drive and property. Bo Walsh Works / Felling of TPO Trees
102 2015/1128/FUL 72A Selwood Road Frome Somerset BA11 3BP Market Mr John Burns Alteration of existing window opening to rear of property to form doorway to provide access to adjacent private patio area and replacement of existing damaged door to Communal Hallway. Elstob Full Application 103 2015/1129/LBC 72A Selwood Road Frome Somerset BA11 3BP Market Mr John Burns Alteration of existing window opening to rear of property to form doorway to provide access to adjacent private patio Lorna Elstob Listed Building Consent
area and replacement of existing damaged door to Communal Hallway 104 2015/1170/REM Land To The East Of Southfield Farm Rodden Somerset BA11 5LB Keyford Mr David Hagan Application for Reserved Matters Approval for Appearance, Landscaping, Layout and following outline permission 2013/1635. Oliver Marigold Reserved Matters Application 105 2015/1214/LBC 14 Horton Street Frome BA11 3DP + Mrs T Pascucci Alter kitchen window opening and fit new oak window on the rear ground floor. Robert Palmer Listed Building Consent 106 2015/1217/FUL Tong Dynasty Keyford Mr James Hatt Change of use of ground Carlton Langford Full Application
Wallbridge Frome Somerset BA11 5JX floor and first floor from a public house premises (Class A4) to a physiotherapy clinic (Class D1). Second floor to be retained as residential use. 107 2015/1179/LBC Garden House 30 Fromefield Frome Somerset BA11 2HE College Ms GILLIAN WAUGH Internal alterations and installation of solar panels to flat roof at rear. Robert Palmer Listed Building Consent 108 2015/1182/TCA The Coach House Leaze House Mews Vallis Road Market Mr Barry Buckfield T1. Beech - crown reduce by 30%; T2. Sequoia - crown reduce by 30% Bo Walsh Works / Felling of CA Trees
Frome BA11 3EF 109 2015/1230/HSE Everest 48A Bath Road Frome Somerset BA11 2HH College Mr Peter Backwill Rear extension of existing detached dwelling to create an accessible annexe with car port. Carlton Langford Householder
Sl. No Exam Passed Year of Passing Percentile Score Rank 16. Details of UG / PG dissertations: Sl. No Dissertations Name and Details of the Supervisor Brief about the dissertations UG PG M.Phil Others 17. Details of employments / experience:(Attach Photocopies for Proof) Teaching/Industry/Research Total (in years) ………. S. No. Name and Address of Employer Designation Pay-Scale Period Nature of Work From To 18. Research Publications: (a) Papers published in National / International Journals: (Attach Photocopy of First Page of Paper): S. No. Title of the Paper Author(s) Name of the Journal / Publishers Vol. Year & Page No. Impact Factor
3. Details of referees Referee 1 Name of home university: Faculty: Department/Institute: Address: Website: E-mail: Telephone: Referee 2 Name of home university: Faculty: Department/Institute: Address: Website: E-mail: Telephone: 4. Mobility Mobility: part of the MCEC program will be cofunded from resources from the European Commission, and therefore information on mobility is needed. Please specify for the period of 3 years immediately prior to the call deadline (i.e. Novemer 1 2018) if you have resided or carried out your main activity (work, studies, etc.) in the Netherlands for more than 12 months in the 3 years immediately prior to that date. Compulsory national service and/or short stays such as holidays are not taken into account and neither is time that was part of a procedure for obtaining refugee status under the Geneva Convention. Your specification: