由候選人填寫 To be completed by the nominee ( 請用黑色或藍色原子筆及正楷書寫 ) (Please complete the form in black or blue and in block letters) A. 個人資料 PERSONAL PARTICULAR

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杷驱秋
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1 提名表格 NOMINATION FORM 截止日期 :2018 年 12 月 31 日 ( 下午 5 時正 ) DEADLINE:31 December 2018 (by 1700 hrs) 主辦單位 Organizer: 香港童軍總會提名表格請交回 : SCOUT ASSOCIATION OF HONG KONG 九龍柯士甸道童軍徑香港童軍中心 10 樓香港童軍總會公共關係署 ( 註明 :2018 年度模範童軍選舉 ) NOMINATION FORMS ARE TO BE RETURNED TO: Public Relations Branch Scout Association of Hong Kong 10/F, Hong Kong Scout Centre, Scout Path, Austin Road, Kowloon (Re: Scout of the Year Selection 2018) 贊助單位 Sponsors: 李逢泰先生 Mr LEE Fung-tai 香港童軍總會公共關係委員會主席 Chairman of Public Relations Committee of SAHK 吳振雄先生 Mr Ken NG Chun-hung 香港童軍貝登堡聯誼會會長 President of The Baden-Powell Scout Club of Hong Kong 永同益置業有限公司 Wing Tung Yick Investment Co., Ltd.

2 由候選人填寫 To be completed by the nominee ( 請用黑色或藍色原子筆及正楷書寫 ) (Please complete the form in black or blue and in block letters) A. 個人資料 PERSONAL PARTICULARS 1. 姓名 : ( 中文 ) Chinese Name ( 英文 ) English 2. 出生日期 Date of Birth : ( 歲 / years old) 3. 出生地點 Place of Birth : 4. 性別 Sex : 5. 住址 : ( 中文 ) Chinese Residential Address: ( 英文 ) English 6. 電郵地址 Address : 7. 電話 Telephone No. : ( 日 ) Day ( 夜 ) Night 8. 隸屬童軍旅 : ( 地域 )Region ( 區 )District ( 旅號 )Group No Scout Group 9. * 職業 / 就讀班級 *Occupation/Current Year in School : ( 就讀大專或大學之候選人須填上就讀課程名稱 ) (For students of tertiary institutions, please specify the name of the programme that you are studying.) 10. * 學校 / 僱主名稱 : ( 中文 ) Chinese ( 英文 ) English *Name of School/ Employer 11. * 學校 / 僱主地址 *Address of School/Employer : 12. 本人曾以 * 幼童軍 / 童軍 / 深資童軍 / 樂行童軍支部成員身份參加年舉行之模範童軍選舉, 是次是第 * 一 / 二 / 三次參加 This is the *1 st / 2 nd / 3 rd time I participate in the Scout of the Year Selection. I had participated in Year as a *Cub Scout/ Scout/ Venture Scout/ Rover Scout. * 請刪去不適用者 Please delete where inappropriate 相片 Photo ( 恕不接受打印機列印之照片 No photo printed from printer) ( 必須穿著整齊現屬支部的童軍制服 Submitted photo must be in full Scout uniform of the section to which you currently belong) 13. 通曉語言 Language Proficiency * 請在適當空格加上號 Please where appropriate 會話 Oral 書寫 Written 優異 Excellent 良好 Good 不諳 N/A 優異 Excellent 良好 Good 中文 Chinese ( 粵語 Cantonese) 英文 English 不諳 N/A B. 童軍服務紀錄及成就 SCOUT SERVICE AND ACHIEVEMENT 14. 我現屬及曾隸屬下列童軍支部 I am currently participating and have participated in the following Scout section(s). 請附上現仍有效之支部紀錄冊中的個人紀錄 ( 附有照片 ) 及會員資格紀錄 ( 附有旅印及負責領袖簽名 ) 的副本 Please attach photocopy of the personal record (with photo) & the membership record (with group chop & signature of the Scouter-in-charge) in your currently valid Record Book. 幼童軍 Cub Scout 童軍 Scout 深資童軍 Venture Scout 樂行童軍 Rover Scout 由 From 至 To 由 From 至 To 由 From 至 To 由 From 至 To ( 月 / 年 ) ( 月 / 年 ) ( 月 / 年 ) ( 月 / 年 ) ( 月 / 年 ) ( 月 / 年 ) ( 月 / 年 ) ( 月 / 年 ) (Month/ Year) (Month/ Year) (Month/ Year) (Month/ Year) (Month/ Year) (Month/ Year) (Month/ Year) (Month/ Year) 1

3 15. 我現 / 曾任下列職位 : I am currently holding/had held the following posts: 職位 RANK 由 From ( 月 / 年 ) (Month/ Year) 至 To ( 月 / 年 ) (Month/ Year) 副隊長 Second 幼童軍 Cub Scout 隊長 Sixer 副隊長 Assistant Patrol Leader 童軍 Scout 小隊長團隊長 Patrol Leader Senior Patrol Leader 深資童軍 Venture Scout 主席 Chairperson 樂行童軍 Rover Scout 主席 Chairperson 其他 ( 請列明 ) Others (Please specify) 16. 我曾考獲以下獎章及徽章 ( 暫時無須附上有關證書影印本 ) I have attained the following awards and badges (No need to attach photocopies of certificates at this stage): a) 幼童軍 Cub Scout (i) 考獲幼童軍進度性徽章 Cub Scout Progressive Badges attained 獲獎日期 Date Attained ( 月 / 年 ) (Month/ Year) 申請中 ( 如適用請加上, 並附上支部紀錄冊有關部分之副本, 證明你已通過有關的進度性獎章的所有考核 ) Application in Progress (Please insert a if appropriate and submit photocopy of the relevant part of your Record Book in proving that you have passed all the tests of the Progressive Badge in question) 幼童軍獎章幼童軍歷奇章 Cub Scout Award Cub Scout Adventure Award 幼童軍高級歷奇章 Cub Scout Adventure Crest Award 金紫荊獎章 Golden Bauhinia Award (ii) 考獲活動徽章總數 Total number of Activity Badges attained 2

4 b) 童軍 Scout (i) 考獲獎章 Scout Progressive Badges Attained 獲獎日期 Date Attained ( 月 / 年 ) (Month/ Year) 申請中 ( 如適用請加上, 並附上支部紀錄冊有關部分之副本, 證明你已通過有關的進度性獎章的所有考核 ) Application in Progress (Please insert a if appropriate and submit photocopy of the relevant part of your Record Book in proving that you have passed all the tests of the Progressive Badge in question) 探索獎章 / 童軍探索獎章 Pathfinder Award 毅行獎章 / 童軍標準獎章 Voyager Award 挑戰獎章 / 童軍高級獎章 Challenger Award 總領袖獎章 Chief Scout s Award (ii) 考獲專科徽章 Proficiency Badges Attained 數量 Number 童軍專科徽章 Scout Proficiency Badges 興趣組技能組服務組教導組 Interest Pursuit Service Instructor 總數 Total c) 深資童軍 Venture Scout 段章 Achievement Badge 獎章 Award 深資童軍獎章 Venture Scout Award 榮譽童軍獎章 HKSAR/ Dragon Scout Award 獲取各段章 / 金帶日期 Date Attained 責任 Responsibility 自立 Self-reliance 活動 Activity 探險 Exploration 獲取深資童軍 / 榮譽童軍獎章日期 Date of attaining The Venture/ HKSAR/ Dragon Scout Awards ( 如有關獎章仍在申請中, 須註明並附上支部紀錄冊有關部分之副本, 證明你已通過有關的進度性獎章的所有考核 Please specify if the application of the award is still in progress, and submit photocopy of the relevant part of your Record Book in proving that you have passed all the tests of the Progressive Badge in question) 3

5 d) 樂行童軍 Rover Scout 獎章 Award 樂行童軍獎章貝登堡獎章日期 Date Rover Scout Award Baden-Powell Award 考取日期 Date Attained ( 如有關獎章仍在申請中, 須註明並附上支部紀錄冊有關部分之副本, 證明你已通過有關的進度性獎章的所有考核 Please specify if the application of the award is still in progress and submit photocopy of the relevant part of your Record Book in proving that you have passed all the tests of the Progressive Badge in question) C. 學業 / 事業及有關成就 ACADEMIC/PROFESSIONAL AND RELATED ACHIEVEMENTS 按日期順序列出 in chronological order 17. 學業成就 Academic Achievements (i) 在校最近三年考試成績 ( 請附上有關成績表影印本 ) Annual examination results in the last THREE years. (Please attach photocopies of reports) 年份 Year 成績 Examination Results (ii) 教育程度 ( 暫時無須附上成績表影印本 ) Education Qualifications (No need to attach photocopies of the certificate(s) at this stage) 考試名稱年份成績 Examination Results Name of the Examinations Year ( 請詳列各科成績 Please state your grade of all subjects taken in detail) 香港中學會考 Hong Kong Certificate of Education Examination 香港高級程度會考 Hong Kong Advanced Level Examination 香港中學文憑考試 Hong Kong Diploma Secondary Education Examination 其他 ( 請列明 ) Others (Please specify) 4

6 (iii) 最近三年在校內 / 校外曾獲之獎勵 ( 請填寫不多於 15 項, 暫時無須附上有關獎勵之證明文件 ) Awards received from school or other organizations in the last THREE years (Only a maximum of 15 awards may be included, no need to attach documentary proof at this stage) 獎勵名稱及性質 Title/Nature of Award 獲取年份 Year Attained (iv) 最近三年曾參加以下之課外活動 ( 請填寫不多於 15 項 ) Participation in Extra-Curricular Activities in the last THREE years (Only a maximum of 15 activities may be included) 小組 / 組織名稱 Name of Club/Organization 日期 ( 由至 ) Date (From to ) 職位 Position 5

7 18. 職業 Employment 僱主名稱 Name of Employer 職位 Position 受僱日期 Duration of Employment 19. 除了上述所列各項, 請亦考慮以下事項 In addition to the foregoing, please also consider the following. D. 社會服務及貢獻 COMMUNITY SERVICES AND CONTRIBUTION 按日期順序列出 in chronological order 20. 最近三年曾參加之社會服務計劃及活動 ( 請填寫不多於 15 項 ) Participation in community service projects and activities in the last THREE years (Only a maximum of 15 projects and activities may be included) 活動名稱主辦機構活動性質負責項目年份 Name of Activity/Project Organizer Nature of Responsible Item Year Activity/Project 6

8 E. 短文 Short essay 幼童軍候選人需隨本提名表格遞交一篇約 200 字的短文 ( 中英均可 ), 題目是 : 你覺得模範童軍應具備甚麼條件? 請另頁書寫童軍深資童軍及樂行童軍候選人需隨本提名表格遞交一篇約 300 字的短文 ( 中英均可 ), 談談你覺得你有甚麼優勝之處, 比別人更值得獲選為模範童軍? 請另頁書寫 Cub Scout nominees Please write a short essay (around 200 words in Chinese or English) on In your view, what attributes should a Scout of the Year possess?. Please use separate sheet Scout/ Venture Scout/ Rover Scout nominees Please write a short essay (around 300 words in Chinese or English) on Why do you think you are a more suitable nominee than others to be selected as Scout of the Year?. Please use separate sheet 7

9 F. 證明書 CERTIFICATION 21. 本人確認上述每一項資料均屬正確無訛 I hereby confirm that the above information is true and correct. 22. 本人接納如所提供的資料有不實之處, 或未能按要求提交任何隨提名表格夾附的學業成績表 / 單及證書正本作核對, 將被取消參選資格 I accept that any failure to supply truthful information or to present the original copies of attached academic reports and certificates for verification will lead to disqualification. 23. 本人授權評審團對本人的資料作審核, 並在有需要時向推薦人, 即校方 / 僱主領袖及家長 / 監護人, 以及有關學校和機構查取有關本人的資料 I hereby authorize the Selection Panel to verify the information and documents submitted herewith and obtain further information about me from the referees (school/employer, leader and parent/guardian), school(s) and organization(s) concerned if necessary. 24. 本人明白如獲選為模範童軍, 本人有責任並必須履行香港童軍總會交付的任務, 執行使命 I understand that I am under an obligation to and must discharge all the duties to be assigned by the Scout Association of Hong Kong if I were selected as a Scout of the Year. 候選人簽署 Signature of Nominee 日期 Date G. 童軍旅提名書 NOMINATION BY SCOUT GROUP 25. 茲證明 : 本人 (* 旅長 / 副旅長 / 現屬支部團長 / 現屬支部副團長 ) 代表本旅推薦參加 2018 年度模範童軍選舉 This serves to certify that I (*Group Scout Leader / Assistant Group Scout Leader / Scout Leader (of the section to which the nominee currently belongs) / Assistant Scout Leader (of the section to which the nominee currently belongs)), representing our Group, nominate to participate in Scout of the Year Selection 簽署 Signature : 姓名 ( 請用正楷 ) Name (Please use BLOCK LETTERS) : 職位 Post : 手提電話號碼 Mobile phone number : 旅印 Scout Group Chop : 日期 Date : * 請刪去不適用者 Please delete where inappropriate 8

10 備註 Remarks 1. 候選人須填妥提名表格各項, 並提供正確資料 Please ensure that all parts in the form are completed and the information is accurate. 2. 提名表格須連同一封由家長 / 監護人所發出之推薦信 ( 須附日間聯絡電話 ) 一併呈交 All nominees must submit together with this nomination form a recommendation letter (with daytime contact number) issued by the nominee s parent/guardian. 3. 如候選人屬在職人士, 須在呈交提名表格時一併提交由僱主發出之工作證明副本 If the nominee is working, he/she must submit copy of proof of employment together with this nomination form. 4. 候選人在提名表格上所提供的個人資料, 將用於模範童軍選舉及與選舉有關的事宜如有需要, 有關資料可能會送交香港童軍總會其他部門, 用作與童軍活動有關的用途 The personal data provided in the form will be used for the Scout of the Year Selection and other selection-related purposes. It may also be provided to other branches of the Scout Association of Hong Kong for purposes relating to Scouting activities. 5. 參選人於遞交提名表格當天必須介乎足 11 至足 26 歲, 並屬已宣誓或覆誓的現屬支部成員如候選人以郵寄方式遞交提名表格, 郵戳日期將被視作遞交提名表格日期 The nominee must be between the 11 th birthday and the 26 th birthday on the date of submission of the nomination form and have made or reaffirmed the Scout Promise to be a Scout member of the Scout section to which he/she currently belongs. If the nomination form is submitted by post, the date of the postmark shall be taken as the date of submission. 6. 由遞交提名表格至頒獎典禮期間, 如候選人 * 晉升團 * 轉旅或童軍身份因任何理由被終止, 候選人須立即以書面形式通知香港童軍總會公共關係署如參選人之童軍身份於上述期間因任何理由被終止, 公共關係署保留取消其參選資格的權利 If the nominee *is promoted to another Scout section, *transferred to another Scout group or his/ her membership is terminated between the time when this nomination is submitted and the Presentation Ceremony, he/she should inform the Public Relations Branch of Scout Association of Hong Kong in writing immediately. The Public Relations Branch reserves the right to disqualify nominee(s) whose membership is terminated for whatever reason during the said period. * 信件需經旅負責人簽署及蓋上旅印 Letter must be endorsed by Scouter-in-charge and with group chop 7. 候選人出席任何遴選活動時, 必須穿著當時所屬的支部制服必須屬已宣誓 / 覆誓為該支部的成員, 以及出示當時有效的支部紀錄冊必須蓋上旅印及由有關領袖簽名, 缺一不可如候選人未能遵守有關規定, 公共關係署保留取消其參選資格的權利 Nominees must wear Scout uniform of the section to which they then belong (Scout Promise must have been made or reaffirmed in the Scout section to which they then currently belong) and present their respective Record Book (with group chop & signature of the Scouter-in-charge) when they attend any Selection activities. The Public Relations Branch reserves the right to disqualify those who fail to fulfill either of the requirements. 8. 候選人必須以郵寄方式或親自遞交提名表格到香港童軍總會公共關係署提名表格一經遞交, 恕不接受任何補加資料公共關係署亦不會退還提名表格或任何附夾資料 / 推薦書 All nominees must submit this nomination form to the Public Relations Branch of Scout Association of Hong Kong by post or by hand. The Public Relations Branch will not accept any supplementary materials from any nominee after he/she has submitted his/her nomination form. Nomination forms and all attached documents (including the recommendation letters) will not be returned. 9. 候選人的童軍會員資格必須符合香港童軍總會政策組織及規條內的要求 Nominees Scout membership must be valid pursuant to Policy, Organisation & Rules of Scout Association of Hong Kong. 10. 已獲選為模範童軍者如再次參選, 將不獲受理 Past Scouts of the Year are not eligible for re-selection. 11. 提名表格和任何夾附的資料, 包括成績表影印本和短文等, 均不可插入任何文件夾或套摺內 Nomination Form and supporting documents, including the photocopies of academic reports and Short Essay should NOT be inserted in any documents folder. 9

11 12. 香港童軍總會公共關係署保留修改有關選舉規章之權利 The Public Relations Branch of Scout Association of Hong Kong reserves the rights to amend any selection rules and criteria. 請注意 : 各候選人在現階段只需提交部分證明文件副本供大會審閱在遴選較後階段時各候選人須按要求遞交所有證書及其他證明文件正本以供大會核對如候選人未能按要求提交上述文件正本以供核對將被取消參選資格如有候選人虛報資料, 除會被取消參選資格外, 更可能遭刑事檢控 ATTENTION: All nominees are required to submit photocopies of only some of their certificates and documentary proof at this stage. At a later stage, they shall be required to produce ALL of their original certificates and documentary proof for verification. Those nominees who are unable to produce such original copies shall be disqualified. Those nominees who are found to have provided false information may be liable to criminal prosecution apart from being disqualified. 連同提名表格所需遞交的文件清單 Checklist of documents to be submitted together with this nomination form 1. 有效的支部紀錄冊副本包括個人紀錄 ( 附有照片 ) 及會員資格紀錄 ( 附有旅印及負責領袖簽名 ) Photocopy of your valid Record Book, with pages containing your personal record (with photo) and membership record (which must bear the group chop and the Scouter-in-charge s signature) 2. 支部紀錄冊有關部分之副本, 證明你已通過有關的進度性獎章的所有考核 ( 如適用 ) Photocopy of the relevant parts of your Record Book in proving that you have passed all the tests of the Progressive Badge in question (if applicable) 3. 最近三年的成績表副本 ( 如適用 ) Photocopies of School Reports of the last 3 years (if applicable) 4. 一篇短文 ( 請參看 E 部分 ) A short essay (Please refer to Part E) 5. 一封推薦信 ( 請參看備註第 2 點 ) A recommendation letter (Please refer to point 2 of Remarks ) 6. 在職證明副本 ( 請參看備註第 3 點 ) ( 如適用 ) Copy of proof of employment (Please refer to point 3 of Remarks ) (if applicable) 如未能提交所有有關的文件者, 可能會被取消參選資格 FAILURE TO PROVIDE ALL NECESSARY DOCUMENTS MAY RESULT IN DISQUALIFICATION 10

12 SCOUT OF THE YEAR SELECTION 2018 模範童軍選舉 2018 目的 OBJECTIVES 1. 選拔傑出的童軍成員予以表彰, 為其他童軍成員樹立典範 2. 讓社會人士進一步認識童軍的優良品格 1. To give formal recognition to the Scout members who have set the best example to their contemporaries. 2. To arouse public awareness of the outstanding personality of Scouts. 評選標準 SELECTION CRITERIA 模範童軍選舉的主要評選標準乃依據候選人在 (1) 童軍活動上的表現 ;(2) 學業與專業方面的成就 ;(3) 對社區服務的參與及貢獻 ; 以及 (4) 與家庭成員的關係 The nominees accomplishments in (1) Scouting achievements, (2) professional/academic performances, (3) community involvement and contributions, and (4) family affiliation constitute the major criteria for consideration in the selection of the Scout of the Year. 甄選 SELECTION 1. 初選 Preliminary Screening 由多位公共關係署總監組成的評審委員會核實候選人之有關資料, 並選出較優越的候選人進入複選 The Selection Panel which comprises of Commissioners of the Public Relations Branch will verify the data contained in the nomination form and recommend a list of nominees for Semi-Final Selection. 2. 複選 Semi-Final Selection 通過初選之候選人必須出席複選, 並經由香港總監副香港總監助理香港總監及 / 或其他總監所組成的內部評審委員會評核, 表現較佳的候選人將可進入最後評選 Short-listed nominees are required to attend the Semi-Final Selection and assessed by the Internal Selection Panel, members of which include the Chief Commissioner, Deputy Chief Commissioners, Assistant Chief Commissioners and/or other Commissioners. A list of nominees will be recommended for the Final Selection. 3. 最後評選 Final Selection 進入最後評選之候選人將獲社會知名人士青少年 / 社區組織代表及 / 或贊助單位代表組成的外界評審委員會接見, 從而選出本年度之模範童軍 The Finalists are required to attend the Final Selection Interview conducted by the External Selection Panel, members of which are prominent community leaders, representatives of Youth/Community Organizations and/or representatives of sponsors. 選舉結果 ANNOUNCEMENT OF RESULTS 每輪甄選結果將個別以書面通知候選人, 恕不另行通知推薦人或有關單位 Nominees will be informed of the results of the Selection in writing individually. ( 所有入圍者如未能出席複選 / 最後評選, 將作棄權論 Short-listed nominees who are not able to attend the Semi-Final Selection/Final Selection are regarded as withdrawing from the Selection.) 查詢 ENQUIRIES ( 公共關係署 Public Relations Branch) DEADLINE: 31 December 2018 (by 1700 hrs) (Postmark no later than 31 December 2018) 截止日期 :2018 年 12 月 31 日 ( 下午 5 時正 ) ( 郵戳所示日期最遲為 2018 年 12 月 31 日 ) 11

Microsoft Word - (web)_F.1_Notes_&_Application_Form(Chi)(non-SPCCPS)_16-17.doc

Microsoft Word - (web)_F.1_Notes_&_Application_Form(Chi)(non-SPCCPS)_16-17.doc 聖保羅男女中學學年中一入學申請申請須知申請程序 : 請將下列文件交回本校 ( 麥當勞道 33 號 ( 請以 A4 紙張雙面影印, 並用魚尾夾夾起 : 填妥申請表並貼上近照小學五年級上下學期成績表影印本課外活動表現及服務的證明文件及