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["广东省卫生系列高级专业技术资格实践能力考试报名表"]
["用户名：　　　　　　　条形码：　　　　　　　　确认考点： 　"]
["基本信息",null,"姓    名",{"$nulls":4},"性    别",{"$nulls":5},"照 片"]
[null,null,"出生日期",{"$nulls":4},"民    族"]
[null,null,"证件类型",{"$nulls":4},"证件编号"]
["现有资格信息",null,"执业类别",{"$nulls":4},"执业范围"]
[null,null,"执业地点"]
[null,null,"现专业技术资格名称",{"$nulls":6},"取得时间"]
[null,null,"现聘任专业技术资格名称",{"$nulls":6},"聘任时间"]
[null,null,"拟申报专业",{"$nulls":4},"拟申报资格"]
[null,null,"报考专业",{"$nulls":4},"报考级别"]
["教育情况",null,"最高学历",{"$nulls":4},"最高学位"]
[null,null,"参评学历",{"$nulls":4},"参评学位"]
[null,null,"毕业专业",{"$nulls":4},"毕业学校"]
["工作情况",null,"单位名称",{"$nulls":5},"单位所属"]
[null,null,"从业年限"]
["联系方式",null,"联系电话",{"$nulls":5},"邮   编"]
[null,null,"地    址"]
["其他",null,"是否属于欠发达地区乡镇卫生院人员",{"$nulls":4},"是（      ）    否（       ）"]
["备注"]
["以下由审核部门填写盖章"]
["审查意见","所在单位审核意见",{"$nulls":4},"主管部门审查意见",{"$nulls":3},"地级以上市卫生行政部门审查意见"]
[null,"               （公章）",{"$nulls":4},"               （公章）",{"$nulls":3},"               （公章）"]
[null,"               年 月   日",{"$nulls":4},"                年 月   日",{"$nulls":3},"                年 月   日"]
["备注：此表须申报人员仔细核对后签字确认，一旦确认不得修改。 "]
["申报人员签名： 日期： 年 月 日　　"]

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