完整版)放射工作人员证申请表
XXX
n Unit (Stamped):
n Date:
ns:
1.In the "n Diagnosis and Treatment Project" column。fill in XXX。nuclear medicine。XXX。X-ray imaging diagnosis。XXX。maintenance。industrial testing。etc.
2.In the "Work n" column。fill in the department。department。workshop。job type。etc。In the "n Type" column of the "Applicant Basic n Form"。fill in the initial n。change。etc。If the n type is "change"。please specify the change content。The "Applicant Basic n Form" can add nal pages.
3.This n form and XXX materials must be on A4 XXX page by page。If the submitted materia
ls are copies。it should be clearly marked on the copy as "a copy of the original" and stamped with the unit's official seal。
4.Please fill in or print the n form in black or blue pen。The content should be complete。accurate。and the handwriting should be neat and clear。The n unit should download and print the n form in the same format as the online n form。using A4 paper and not making any changes.
5.The same project in the n materials should be consistent and in order。The "XXX Type Code" should be filled in according to the following table.
Unit Name:
Unit Address:
XXX:
XXX:
Contact Person:
n Work Project:
Contact Method:
Mobile Phone:
Postal Code:
Number of n XXX:
License Number:
n Project: n Worker Certificate
Supporting Documents: (Please check the box before the provided materials)
XXX。XXX (copy)。XXX.
XXX (copy).
3.One 2-inch recent photo of the applicant (with the name and work unit written on the back).
XXX and a copy of the ID card of the authorized person (provided when the applicant is not the legal XXX).
5.Other materials (pages).
XXX of supporting documents:
Commitment:
documents安卓版破解版XXX in this n form are true。legal。and comply with the relevant laws。ns。norms。standards。and ns of the country。If there is any false n or infringement。the unit is XXX.
n Unit (Signature):
XXX(Signature): Date:
Applicant Basic n Form
Name:
Gender:
Date of XXX:
Resident ID Number:
Years of Working in n:
Work n:
XXX:
n Type:
Change Project:
Remarks:
XXX
兹委托身份证号为（填写身份证号）的代表，全权负责我单位（或本人）卫生行政许可证件申领工作的相关事宜。该委托书有效期至卫生行政许可证件办结。
委托单位（签章）：
委托人（签名）：
被委托人（签名）：
年 月 日
领取记录：
本人于年 月 日领取我单位放射工作人员证，编号为至。
领取人：（填写领取人姓名）

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