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["附件5"]
["卫生专业技术资格考试考生报考资格审核表（中山）"]
["姓名",null,"出生年月",null,"性别",null,"身份证号"]
["报考级别",{"$nulls":3},"报考专业"]
[]
["学历、学位教育情况（从中专学历填起，中学学历不填）"]
["序号","何年何月起","何年何月止","毕业学校","毕业专业","学制（年）","学历/学位","学习形式                  （全日制/业余）"]
[1]
[2]
[3]
[4]
[]
["取得所有卫生专业技术资格、执业资格情况（未取得资格者填“无”)"]
["序号","级别","资格名称","资格取得时间","发证时间","发证单位",null,"取得方式              （考试/评审/认定/注册）"]
["资格证","士级"]
[null,"师级"]
[null,"中级"]
["执业证","执业资格"]
[]
["取得现资格以来工作履历（未取得资格者填写毕业以来工作履历）"]
["序号","何年何月起","何年何月止","工作单位名称",null,"工作岗位",null,"证明人"]
["单位1"]
["单位2"]
["单位3"]
[]
["\n    考生承诺：我保证本表内容真实、准确，如有虚假信息，本人愿意承担相应的责任！\n\n\n           考生签名：           年   月   日            ",{"$nulls":3},"\n单位意见：\n\n\n\n                   \n                   公章：           年   月   日 "]
[]
["备注：1.该表格请网上填写，打印后需本人亲笔签名。\n      2.请申报者如实填写各项资料，所填项目需和提交材料一致。"]

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