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6 views5 pages

Application Form

Uploaded by

izzelduppont426
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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护照姓 Pongui 护照名 Stiven Prichinnel

Family Name(as on Given Name (as on


passport) passport)
中文姓名 *性别 ☒ Male
Chinese Name (if *Gender ☐ Female
available)
*婚姻状况 single *国籍 Congolese
*Marital Status *Nationality
*出生日期 1/05/97 *出生国家 Congo
*Birth Date *Country of Birth
*出生地点 Dolisie *母语 french
*Place of Birth (City, *Native language
Province)
*最后学历 license *宗教信仰 christian
*Highest Level of *Religion
Education
*工作或学习单位 Estic-Gecom *职业 student
*Current Employer or *Occupation
School Name
健康状况 ☒ Normal 爱好/才艺
Health Status Hobbies/ Talents telephone advisor
☐ Abnormal

证照信息 Passport and Visa

护 照 到 期 日 期
护照号码 OA0631001 Passport Expiry SEP 28
Passport No.
Date
入境次数 逗留时间（月） 签证类型 原因
Entry No Duration(months) visa type Reason
最近三次入境
1
签证记录
3 Recent Visas 2
to China
3
来华经历 Experiences in China

是否在华学习过
☐YES ☒NO
Ever studied in China
before?
If yes, please provide below information as well:

Chinese University Name

Time period Year Month Day - Year Month Day

Study Program Bachelor☐、Master☐、PhD☐ Chinese Language☐

Name:
Contact Teacher
Phone Number: +86

违法违规记录 Illegal Record

*你是否有违法违规记录
☐ YES ☒ NO
*Have you ever had any illegal record?

If you choose YES, please contact your consultant for further explanation

Study Plan in China

英语能力
English Proficiency
*Language
noon☐、poor☐、fair☐、good☒、excellent☐
Proficiency
TOEFL GRE
GMAT IELTS

其他语言能力
Other Language Proficiency

学习或工作经历 Education & Employment Background

*经验类型 *开始时间 *结束时间 *工作或学习单 职务及职称 / 专业或


*Experience Type *Month/Year *Month/Year
位*Employer or 所获证书
Attended Attended
(From) (To) School Name Position& Title / Field
of Study & Diploma
received
JULY 18 JULY 23 ESTIC-GECOM professional license
☒教育 Education

☐工作 Working

☐其他 Others

☐教育 Education MAY 24 AUGUST VOCALIS CALL ADVISOR

☒工作 Working 24 CENTER

☐其他 Others
professional license
☒教育 Education JANUARY NOVEMB IT SCHOOL

☐工作 Working 24 ER 24

☐其他 Others

*家庭成员 *姓名 *年龄 *电话 电子邮件 *职务 *工作单位


*Family *Name *Age *Phone Email *Position/ *Employer
Members Number Job Title Name

Father Pongui 52 +242 engineer GEOLOG


Jean 06411271
6
Mother Nkeoua 45 +2428711
glwadis 910
(Other
members)

其他信息 Other Necessary Information

经济担保人或机构 Financial Guarantor


Pongui Jean
担保人姓名 担保人地址 Tchistere AV
Guarantor Name Detailed Address
congo
DAD
ID/护照号码 与申请人关系
ID/Passport Number Relationship with
Applicant
+242 06 411 27 16
担保人电话 电子邮件
Tel Number Email
GEOLOG ENGINEER
工作单位 工作职位
Employer Name Job Title/Position

紧急事务联系人 Emergency Contact in China


Diambomba 18301764416
*姓名 *手机
Nsounga frantelain
*Name *Mobile Number
cousin diambombafrantelain
*与申请人关系 *电子邮件
@gmail.com
*Relationship with *Email
Applicant
Shanghai jiading
工作单位 *地址
nanxiang jiaotong
Employer Name *Detailed Address road

海外家庭住址 Hometown Contact Info


4*4 rue owando +242 06411 2716
*街道地址*Street *电话
115
Address (Detailed) *Phone Number
Dolisie +241 76419 1402
*省/城市*City/ 手机
Province Mobile

*国家 *邮编
Congo
*Country *Zip Code

个人当前联系方式 Current Personal Contact Info


(Can leave this part if your current address equals to above home address)
个人邮箱 *邮编
Personal Email *Zip Code

*电话/手机 *地址
*Mobile/Phone *Address
Number

WhatsApp 账号 微信账号
WhatsApp No WeChat No

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