Application Form

Which project you are interested in? (Check those that apply)
□ Teaching English
□ TEFL/ TESOL Courses and on job training
□ Teaching and tour combination
□ Learning in China

Personal Information

Surname________________________ First Name ___________ Middle Name ____________
Sex_____ Date of Birth_______________________

Place of birth__________ Complexion □ White □ Yellow □ Brown □ Dark
Height_________(cm) Weight _________(kg)
Mother Tongue_______________ Citizenship____________ Marital Status________
(If married) Spouses Name___________

Present Address____________________________________________________________

____________________________________________________________

E-mail____________________ Telephone___________________ Fax________________

Passport #__________________________________ Expiration Date_______________

Education & Teaching Background

High School __________________________________________________

Bachelor's Degree (major)________________________________________________

Master's Degree (major) ___________________________________________________

Ph.D. (Doctoral thesis) ___________________________________________________

Additional Training________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Teaching Experience (Indicate whether Part-time or Full-time, Location and Dates)

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

Have you ever had any of the following diseases ? (Indicate Yes or No)
Typhus fever_____ Poliomyelitis _____ Diphtheria_____ Scarlet Fever______
Relapsing Fever______ Typhoid and paratyphoid fever______
meningitis______ Brucellosis _______ Viral hepatitis _________
Do you have the following diseases or disorders? (Indicate Yes or No)
Cholera ______ Yellow fever______ Plague _______ Leprosy _______ AIDS______
Venereal disease ______ Opening lung tuberculosis__________
Toxicomania ______ Mental confusion __________Psychosis _________
Physical deformity_____ Congenital Abnormality _______Color blindness_______
Deaf-mute_______ Suffer a Speech Problem________
Suffer from a Chronic Disease ______
Wear a Hearing Aid_______ Have visible Scars, Tats & Birthmarks_______
Abnormality in heart/lungs/liver and/or other viscera________
Contagious skin disease____
Do you have any additional information concerning your health?

__________________________________________________________________________

__________________________________________________________________________

Emergency & Permanent Contact

Name __________________________________ Relationship _______________________
Telephone___________________ E-mail____________________ Fax________________

I am available to go to China from ____________(mm/dd/yyyy),I will depart
from____________(place),

I declare that the information I have given in this application is truthful,
complete and correct.

Date______________________________ Signature _______________________________