Name:
Training subject (audit):
Date of birth:
Gender:
Address:
Telephone, Fax:
E-mail:
URL:
Occupation:
When and where you have attended the special courses:
Passport series:
Issued:
Length of service:
Knowledge of languages :
I confirmed that:
- The information given by me is correct.
- I realize that I will take over the care of my safety during training (qualification session) carrying out.
- I understand that the payment will be paid back in case of frustrated courses (qualification session) only.
- I agree with the point that I may receive a refusal in training (qualification session) courses attendance without additional explanation.
- I was never suffering from any mental disorder and I do not have any contra-indication against attending the training or to sit for a SS-EAST qualification session I declared.
The content of this application will not be passed to a third part but SS-EAST has the right to check this data through the public services.
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