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1、INTERNATIONA1.ATOMICENERGYAGENCY(EAWagramerstrasse，p.o.BOX100,Ai400Vienna(Austria)TE1.EPHONE(U31)2600.FACSIMI1.E：“431)26007EMAI1.:Offiaa.Mai1.iaa.org,TCWEBSITE:http:www-tc.wea.orgNOMINATIONFORTRAININGCOURSENour:Thisfm1.bvusedka1.)forfr1.k*iporMretti11cViXiITheCiovcrnmcnominates(beRntof11.owingcandid
2、atefor(heTniiningCoursen(indicateshort1.ide.p1.ace,da1.es.ProjCC1.cunicnumber):OFema1.eMa1.eDateofbirth:RcvcntphotographofcandidateFami1.yname:P1.aceofbirth:(osinfusspo11Naiiona1.iiy:Firstname:PassportNo.:COmPIetemai1.ingaddress1office):Dateofissue:inst.Name:P1.aceofissue:Va1.idunti1.:Street:Tc1.cph
3、iinc(office):P.O.Box:IPostCode:Te1.ephone(home):Town.Citv:Fax:RegirtnzDiMrici:e*mai1.:Country:WEBPage:AirportZtoMnnearesttoresidence:Enicrgcncvphone:EDUCATIONYearsattendedNameandp1.aceofinstitutionFie1.dofstudyDip1.omaordegreefromtoRECENTEMP1.OYMENTRECORDYearsofSefVieNamea1.p1.aceofcmp1.oycr.orcaniz
4、ationTit1.eofPOSiIiOnTypeofworkfromtoDESCRIPTIONOFWORKTypeofworkdonebythecandidateduringthepast3years(P1.easeattach1.istofanymateria1.thecandidatemayhavepub1.ished)kIhCcundid1.ecoveredunderaradidaebeen,orwi1.1.1.wsbebe,invo1.vedinanyIAEA-supportedTechnica1.Cfpcraiicnproject?(P1.easeidentifyprojectan
5、ddescribethenatu11jOf1.hecandidatesinvo1.vement.)PREVIOUSPARTICIPATIONINANIAEAACTIVITY:I1.as1.hcCiIndKh1.CPartkipiUedinapreviousIAEA;ic1.ivi1.y?Ifyes.p1.ease1.istCad1.activitybe1.ow:RE1.EVANCEOFTHETRAININGHowisbeGovernmentgoingomakeuseOfIbe(miningreceivedby1.candidatea1.wcourse?1.ANGI；AGECERTIFICATE
6、I,a*aqu1.ifrdbogUagCevmier.ItrvbcertifyIhMIhavC(WmiIIedI1.wabo*vCafK1.iudpvcIhv(1.kuigin(1111airuscqua1.fkuttn:(aMotherIggUCofthecandidate:(b)O1.krIUIIgUQgCK(c1.ingMgeoftecorscProficiencyinthe1.anguageofthecourseReadWriteSpeakUnders(axiGoodGOOdGoodGoodAverageAverageAverageAverageP(x1111PoorPrJPrDate
7、Nanic(printed)andsignatureofexaminerMEDICA1.CERTIFICATEI.Jrtftqihi1.ifiedmedia1.dx.herebyocn1.IhUI1.tucCCimtfKd(hedtxvccdhcMk1.tA1.1.infkrmatnMPP1.iCdinthiformMCo1.nPktCandccc11xt:b1.Shou1.dthecnddacbngungcqun1.ifkuiuo。provetobeimufi1.cicntbou!dtheCndiihICMsuite(*hea1.thnotcorrespondotbeCXUmini咤P)Mt
8、iwSMa1.vitwii1.(hem)mia1.:Gvvrn111.i1.1.就VCPfIherepmsibi1.i1.y(Of(hecc5undmicn1.arising1.1.ercfm;OIti%na1.edththeonrinjc%andIK1.ainui1.uciodonoacorp(1.iabi1.ityforhepaymentofyOMbIaromcwwn。所fromtoorIOfAofPCM“1PGWn八arfromI1.1.ness,injury,dab11yxdehofaPUrIH1.(UnIwhi1.ehe,ctInIVeHi吨toandfromrM1.Cndingth
9、miu1.inGwenifnenc,undertakesthervsponibi1.iyRIrSUChvcrc;dIThepMtionfthecAndidutcwi1.1.berencdforhim,hcrndhe*shewi1.1.continueidreceiveduringthetrainingcourcM1.bryJndrebtcdCmohmICngkenab1.eIitnvYwr(mecIfse1.ected,thenomineewi1.1.conducthi11iMr1.fcrc1.finamannerComPMibkwithhinuc1.earintiJbciiMiserinxiuie(kwhereionizingraduu)isued.DateNameandtit1.e(printed)andsignatureofcertifyingGovernmentOfYicia1.
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