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Associate Member Applicants Vetting Checklist
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Name:
Present Working Place:
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Admission Criteria
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1
Self-declaration on no criminal conviction or professional misconduct
*YES / NO
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2
Valid RN Registration Certificate
Year registered
*YES / NO
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3
Valid RN practicing certificate
*YES / NO
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Holder of Master Degree in Nursing or related practice
*YES / NO
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Valid Certificate on related Specialty training
*YES / NO
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Specialty :
Year obtained:
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6Working Experience ( at least 2 years of surgical related ward experience )
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From (MM/YY)
To (MM/YY)
Sub-Total (MM/YY)
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Grand Total
MonthsYears
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Endorsed by HKCSN Administration & Registration Committee
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¨ Accept as Associate Member as from
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¨ Not accept as Associate Member, reason(s)
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(Signature / Name )
(Signature / Name )
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