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111學年度日間學士班、進修學士班實習保險資料
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學號
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姓名
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身分證字號
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出生年月日(如民國90年5月20日,請寫90.05.20)
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緊急連絡人
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緊急連絡人電話
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實習機構
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實習確定日期(開始)
MM
/
DD
/
YYYY
實習確定日期(結束)
MM
/
DD
/
YYYY
聯絡情況
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已經跟實習單位聯絡並確認實習日期
已經跟實習單位聯絡,但尚未確定實習日期
尚未與實習單位聯絡
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