Fillable Part A Applicant No. (Workplace English Campaign)

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Part A Applicant No. (Workplace English Campaign)

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  • 20 check-boxes
  • 83 other fields

Country of origin: HONG-KONG
File type: PDF

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申請人編號
Applicant No.
(只供有關部門填寫 Official use only)
甲部
申請人資料
Part A
Applicant's Personal Particulars
姓氏 Surname 名字 Given Name
姓氏 Surname 名字 Given Name
日 DD 月 MM 年 YYYY
男 女
Male Female
是 否
Are you a permanent resident of the Hong Kong Special Administrative Region? Yes No
(如對香港特別行政區永久性居民身分有任何疑問，可致電入境事務處居留權查詢熱線2824 6111。)
Education Primary Secondary Post-secondary Tertiary or above
Residential Tel No. Mobile Phone No.
Email Address
Residential Address
(如與上址不同)
Name of Employer/Firm/School
Occupation Post/Class
(請在適當方格內加上 號。) 「請轉下頁」 P.T.O
(Please insert a in the appropriate box. )
CAS17 (Rev. 10/2017)
教育程度
Correspondence Address
(If different from the address
given above)
住所電話號碼
流動電話號碼
職業
Address in English:
小學
電郵地址
住址
(必須填寫中文及
英文地址)
通訊地址
(Provision of English
and Chinese address
are mandatory)
中文地址：
Address in English:
民眾安全服務隊登記加入表格
Civil Aid Service Application for Enrolment
(
下列各項均須填寫，如有不適用者，請填
“
不適用
”)
(All particulars MUST be completed. If not applicable, please insert “N.A.”)
(If in doubt, you are advised to make enquiry about your eligibility for the permanent resident status in the Hong Kong Special Administrative Region through the Immigration
Department Right of Abode Enquiry Hotline 2824 6111.)
中學
專上學院
性別
Sex
職位/級別
中文地址：
( )
1
中文姓名
Name in Chinese
英文姓名
Name in English
你是否香港特別行政區永久性居民?
身分證號碼
HKIC No.
出生日期
Date of Birth
申請人近照
Recent Photo of Applicant
大專或以上
乙部
專門技術／專業資格
Part B Special Skills / Professional Qualifications
你持有下列哪類型車輛的駕駛執照？
Which of the following driving license do you hold?
Private Car Medium Goods Bus Others
Please specify
Vehicle
What languages / dialects do you understand? Chinese Comprehension Written Spoken
English
Comprehension Written Spoken
Putonghua Fair Good Fluent
Others Please specify ：
請列出曾經服務的公共團體（例如：紀律部隊、香港輔助警察、民眾安全服務隊、醫療輔助隊或其他單位及青少年組織的服務詳情）
專業資格 / 專門技術（例如律師、會計師、山藝、拯溺、水上活動或急救等）（按獲取專業資格的日期順序列出）
丙部 父母或監護人允准參加民安隊同意書
Part C Parents'/Guardians' consent to join the CAS
(如申請人未滿十八歲，須由父母或監護人在此欄親筆簽名允准，方可報名參加。)
我同意申請人參加民安隊。
I agree to the applicant’s enrolment in the Civil Aid Service.
父母或監護人簽名
Signature of Parents or Guardian
父母或監護人姓名 日期
Name of Parents or Guardian
Date
(請在適當方格內加上 號。) 「請轉下頁」 P.T.O
(Please insert a in the appropriate box. )
youth organisation)
Served public organisation(s) (e.g. disciplinary force, the Hong Kong Auxiliary Police Force, the Civil Aid Service, the Auxiliary Medical Service or any other unit and
2
Level Attained/to be Attained
Professional Qualifications
(If the applicant is under the age of 18, his/her parents or guardian is required to give consent to the applicant’s enrolment in the Civil Aid Service
by signing in this column.)
(Day/Month/Year)
(日/月/年)
Obtained
已達到 / 將達到的程度
Full Name of Issuing Authority
頒發機構全名
持有的專業資格
電單車
私家車
中型貨車
巴士
英文
)
中文
)
( 請註明：_______________ )
會話
其他
你通曉哪幾種語言/方言？
書寫
Motorcycle
(
會話
閱讀
(
(
閱讀
(
書寫
其他
一般
流利
)
)
良好
請註明：
Name of Public Organisation(s)
Service Period (From MM/YY To MM/YY)
Rank & Number
服務期 (由月/年至月/年)
公共團體組織名稱
職級和編號
Professional Qualifications / Special Skills (e.g. lawyer, public accountant, mountaineering, life saving, water sports or first aid) (in chronological order)
獲取 / 將獲取資格的日期
Date Obtained/to be
普通話
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signature
click to edit
丁部 聲明書
Declaration
本人謹此聲明申請書內所填寫的一切資料均確實無訛。
提供的個人資料，或會轉交其他政府決策局和部門。
申請人簽名 日期
Signature of Applicant Date
申請人編號 (只供有關部門填寫)
Applicant No. (Official use only)
姓名 (請填上你的姓名和地址)
Name (Please fill in your name and address)
地址
Address
姓名 姓名
Name Name
地址 地址
Address Address
(請填上你的姓名和地址) (請填上你的姓名和地址)
(Please fill in your name and address) (Please fill in your name and address)
本人已細閱夾附於本申請表內的“民眾安全服務隊條例及規例述要”，並願意遵守香港法例第518章《民眾安全服務隊條例》及香港法例第518A章
Part D
and CAS Regulation (Cap. 518A).
purposes: (i) recruitment, e.g. qualification assessment and medical examination; (ii) CAS enrolment; (iii) any other legitimate purposes as may be required, authorised
ACKNOWLEDGEMENT OF APPLICATION
我們收到你的申請書，現正詳加審閱。若我們進一步考慮你的申請，則會另行發信與你聯絡。
Your application has been received and is now being studied. If your application is further considered, another letter will be sent to you.
申 請 書 覆 函
《民眾安全服務隊規例》為民安隊服務。
I have read the “ Notes on CAS Ordinance and Regulation ” attached to this form. I will serve the CAS in accordance with the provisions of the CAS Ordinance (Cap. 518)
I hereby declare that the statements that I have set forth in this application form are true to the best of my knowledge and belief.
本人明白並同意，如有需要，上述資料會供民眾安全服務處／民眾安全服務隊作下列一項或多項用途：(i) 招募事宜，例如學歷評審和體格檢查；
(ii) 登 記 加 入 民 安 隊 ； (iii) 供 法 例 規 定 、 授 權 或 准 許 的 其 他 合 法 用 途 ， 例 如 處 理 支 發 及 歸 還 制 服 。 為 了 執 行 上 述 工 作 ， 申 請 人 在 本 表 格
or permitted by law, e.g. issue and return of uniform. The personal data provided in this form may be disclosed to government bureaux and departments for the
purposes mentioned above.
I understand and accept that the information given above will be used by the Civil Aid Service (department and volunteer service) for one or more of the following
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signature
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Notes注意事項
請填妥申請表格，並以郵寄方式交回九龍油麻地渡華路八號民眾安全服務隊總部四樓紀錄室。
during office hours.
after submission of this form may be forwarded to the Records Office, CAS Headquarters in writing (i) by post to the Records Office, 4/F, CAS Headquarters,
8 To Wah Road, Yau Ma Tei, Kowloon; (ii) by fax at 2576 3021; or (iii) by email to casenq@cas.gov.hk. For enquiries, please call 3651 9383 or 3651 9375
Completed enrolment form should be sent by post to the Records Office, 4/F, CAS Headquarters, 8 To Wah Road, Yau Ma Tei, Kowloon.
申請人在本表格內所提供的個人資料，會供民眾安全服務處／民眾安全服務隊作下列一項或多項用途：(i) 招募事宜，例如學歷評審和
體格檢查；(ii) 登記加入民安隊；(iii) 供法例規定、授權或准許的其他合法用途，例如處理支發及歸還制服。為了執行上述工作，申請人
在本表格上所提供的個人資料，或會轉交其他政府決策局和部門，以及其他機構。在一般情況下，申請人如未獲錄取，將獲專函通知，而其
(i) recruitment, e.g. qualification assessment and medical examination; (ii) CAS enrolment; (iii) any other legitimate purposes as may be required, authorised or
within 6 months from the date of notification.
The information is provided at the applicant’s own free will. The applicant is required to notify the CAS Headquarters immediately if there are any changes to the
如有查詢， 請於辦公時間致電 3651 9383 或 3651 9375。
The personal data provided in this form will be used by the Civil Aid Service (department and volunteer service) for one or more of the following purposes:
information provided in this form. Application without sufficient information will not be processed. Request for access or correction of the personal data provided
(3).
所有資料由申請人自願提供。本表格所填事項如有任何變更，須立即通知民眾安全服務隊總部。另外，申請人如未能提供所需資料，其申請
提出：(i) 郵寄至九龍油麻地渡華路八號民眾安全服務隊總部四樓紀錄室； (ii) 傳真至 2576 3021；或 (iii) 電郵至 casenq@cas.gov.hk。
將不獲受理。提交申請表格後，如欲查閱或修改填報於本申請表格內的個人資料，可透過以下方式以書面向民眾安全服務隊總部紀錄室
(1).
permitted by law, e.g. issue and return of uniform. The personal data provided in this form may be disclosed to government bureaux, departments and other organisations
for the purposes mentioned above. Unsuccessful applicants will be notified of their application result by post and all their personal information will normally be destroyed
(2).
個人資料將在該通知書發出日起計六個月內全部銷毀。
一、
登記加入民安隊：
(甲)
申請人必須年滿十六歲，如年齡在十八歲以下，必須獲得其父母或監護人的書面同意；
(乙) 申請人必須通過模擬職能及體能測試，方可獲准登記加入民安隊；
(丙)
(丁) 申請人須操流利粵語並能閱讀及書寫中文，以及具備中三或以上學歷；
(戊) 申請人須以書面同意在獲准加入民安隊後，隊員須按照(強制性公積金條例)作出強制性供款；
(己)
須簽署處長規定須簽署的表格；
(庚)
須提交處長規定須提交的個人詳情。
二、
三、
四、 效率的要求：任何隊員在效率方面的要求為每年須努力完成六十小時的訓練。
五、
六、 薪俸與津貼：
(甲)
(一)
隊員如服務不足八小時，薪津依照時薪率計算；
(二)
(乙)
七、
八、
九、 辭職：除遇緊急事故期間以外，隊員可按照下列規定，申請辭職：
(甲)
在廿八天前，經由所屬單位的主管長官以書面通知民安隊處長；
(乙)
交出所有屬公共財產或民安隊財產的制服及裝備，而交出的制服及裝備須狀況良好；
(丙)
交回由處長發給的任何身份證明文件；
(丁)
繳付欠繳的任何費用。
十、 解職：處長有權根據單位主管長官的建議，隨時將任何隊員解職。
十一、 退休：除非處長另有指示，否則所有隊員均須在年滿六十歲時退休。
十二、
十三、 離開香港；更改詳情：隊員須向處長報告以下事情：
(甲)
隊員擬離開香港七天或超逾七天；
(乙)
隊員在登記加入時提供的詳情的任何更改。
處罰：任何隊員犯了違紀行為，如不服從命令，或在一年度內沒有達致在效率方面的要求等，得受降級、警誡、譴責或罰款等
處分。
口糧津貼：隊員參加服務達八小時或超過八小時，而在該段時間內無免費膳食或口糧供應，可領取規定的口糧津
貼。
民眾安全服務隊條例及規例述要
(摘自《民眾安全服務隊條例》及《民眾安全服務隊規例》)
隊員由報到時間起計的二十四小時內(不論該二十四小時是否在同一天內)，如服務足八小時或超過八小時，薪津
按日薪率計算。
裝備：隊員須謹慎和安全地保管其隊員證和裝備，並在離開民安隊或奉命交還隊員證和裝備時，將之悉數歸還。故意或因疏忽
而損壞、毀滅或遺失裝備，須受懲罰或罰款。
隊員凡參加訓練或在緊急事故期間奉召執勤，或自願在災場協助而得在場長官許可，其薪津將按照職階和下列規定
而支付：
傷殘或死亡：隊員如在奉召執勤或參加訓練時因意外引致傷殘或死亡，經政府醫生認為是歸因於執行該職責所致的，可獲考慮
發給撫恤金、津貼或長俸。
醫療：隊員如在奉召執勤或參加訓練時受傷或染病，經政府醫生認為是因執勤所致，得由政府當局給予免費醫療及住院治療，
並在缺勤期間，按其職階獲支付薪酬。
民安隊的動員：在有需要時，民安隊處長可動員整支民安隊或其任何部分執勤。屆時，所有隊員必須到達指定地點值勤，執行
指定職務。
申請人在獲准登記加入民安隊前必須接受政府規定的體格檢驗，其後亦須定期接受檢驗。如該隊員不能通過體格檢驗，其登記加
入可予取消；
服務條件：任何隊員於完成其入職訓練一年內，如無合理辯解辭職離開民安隊，或於其入職訓練後一年內被解職或其登記加入被取消
，該隊員在處長提出要求的情況下須就其在民安隊所接受的入職訓練向民安隊繳付合理的費用。
1
Enrolment
(a)
(b) Every applicant must pass the functional and fitness tests before he/she can be accepted for enrolment;
(c)
(d) Every applicant must be able to read and write Chinese, and speak fluent Cantonese, and has attained an education level of Form 3 or above;
(e)
(f) Every applicant must sign such forms as the Commissioner may require; and
(g) Every applicant must furnish such personal particulars as the Commissioner may require.
2
3
4
5
6
Pay and Allowances
(a)
(i) in respect of attendance for less than 8 hours at the hourly rate of pay;
(ii)
(b)
7
8
9
Resignation. Except during an emergency, a member may resign upon:
(a)
giving the Commissioner not less than 28 days’ notice in writing, through Company/Unit Commander;
(b)
(c)
surrendering any document of identity issued to him by the Commissioner; and
(d) pay any moneys due from him.
10
11
Retirement. Unless the Commissioner otherwise directs, a member shall retire upon reaching the age of 60 years.
12
13
Absence from Hong Kong; change of particulars. A member shall report to the Commissioner:
(a) his intention to be absent from Hong Kong for any period of 7 days or more;
(b) any change in the particulars provided by him upon enrolment.
Liabilities. Any member who, commits an offence against discipline, such as failing to obey an order or failing to achieve the required standard
of efficiency in any year, shall be punished with a reduction in rank, a caution, reprimand or a fine.
When a member is called out on active service in an emergency or for training, or he voluntarily assists at a disaster incident with the
approval of the senior officer present, payments will be made according to his grade as follows:
in respect of attendance for 8 hours or more in any period of 24 hours, at the daily rate of pay. Each period of 24 hours is
calculated from the time of reporting for duty, whether that period is wholly in one day or partly in one day and partly in another
day.
Ration Allowance. A member who attends for duty for 8 hours or more in any period of 24 hours during which he is not provided with
free meals or rations, is eligible to receive a daily ration allowance.
Medical Attention. Any member who, when called out on active service or in training, sustains any wound or injury or contracts an illness
which is, in the opinion of a medical officer, caused by such service shall be provided with free medical and hospital treatment arranged by the
Government. During the period of any absence from duty necessitated by the injury or illness, receive the pay and allowance according to his
grade.
Disability or Death. Any member who, when called out on active service or in training, sustains death or disability which is, in the opinion of a
medical officer, attributable or aggravated by such service, shall be considered eligible for the grant of a gratuity, allowance or pension.
delivering up in good order all uniform and equipment provided to him and which is either public property or Service property;
Discharge. The Commissioner is authorized to discharge at any time any member on the recommendation of his Company/Unit Commander.
Notes on CAS Ordinance and Regulation
Calling-out of Service. The Commissioner may call out on active service the whole or any part of the Service. All members shall then attend at
such places and perform such duties as may be assigned.
Requirements for efficiency. The requirements for efficiency of a member in any year shall be 60 hours performance of training with diligence.
Equipment. Every member must carefully and safely keep his CAS identity card and any other equipment issued to him and return them when
ceasing to be a member, or when ordered to do so. Any damage, destruction or loss of such equipment out of intention or negligence shall be
subject to punishment or fine.
Terms of service. A member who, without reasonable excuse, resigns from the Service, or who is discharged or whose enrolment is cancelled,
within one year of the completion of his recruitment training shall upon request by the Commissioner pay to the Service the reasonable costs of
his recruitment training in the Service.
Every applicant must make mandatory contribution to the Mandatory Provident Fund as stipulated under the Mandatory Provident
Schemes Ordinance upon successfully enrolled as a member of the Service;
Every applicant must pass a Government medical examination before he can be accepted for enrolment. He must also be prepared to
undergo further medical examinations periodically. If a member enrolled in the Service fails to pass such examination, his/her enrolment
may be cancelled;
Applicants must be over the age of 16. Any applicant under the age of 18 must first obtain the written consent to join from his parents or
guardian;
(Extracted from CAS Ordinance & CAS Regulation)
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Part A Applicant No. (Workplace English Campaign)

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Completed 5 November 2020

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