中小学英语教师选派项目申请表 Click to download help document. Click to download application form or fill the form online. Please fill in all fields truthfully and to the best of your knowledge. Personal Information Surnames Given names Full Name in Chinese Sex Female Male Have you ever used other names? Yes No If yes, please write the full name in native alphabet : Marital Status Date of Birth (YYYY/MM/DD) Province of Birth City of Birth Married Single De facto Nationality National Identification No. U.S. Social Security No. Contact information Street Address City Province ZIP Code Country Is your Mailing Address the same as your Home Address? Yes No If No, please write your mailing address below: Primary Phone No. Secondary Phone No. Work Phone No. Emergency No. Email Address Passport Information Passport Type REGULAR OFFICIAL OTHER Passport No. Passport Book No. Issue Date Expiration Date Issued Place Authority Issued Have you ever lost a passport or had one stolen? Yes No Have you ever been in the U.S.? Yes No Have you ever been issued a U.S. Visa? Yes No Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry? Yes No Family Information Surnames Given Names Date of Birth (YYYY/MM/DD) Spouse Child 1 Child 2 Is your spouse or your children in the U.S.? Yes No Do you have any immediate relatives, not including parents, in the United States? Yes No Education Information Date (YYYY/MM/) Degrees/Diploma/Certificate Type Major English Proficiency Type Superior Near-Native Native Work Information Employment information for the last five years Current Prior1 Prior2 Dates of Employment Employer Address City, Province Position Title Professional Title Age and grade of students Employer Phone No. All teaching experience except mentioned above Current Prior1 Prior2 Dates of Employment Employer Address City, Province Position Title Professional Title Age and grade of students Employer Phone No. Have you ever taught in the US? Yes No Training Information List any applicable special skills, training or proficiencies.