宁波市“3315计划”外裔创新人才申报书.doc

1、附件5 本 表 格 仅 供 参 考 ，以 网 上 申 报 系 统 表 格 为 准Appendix 5 Please read “instructions” carefully before filling in the forms.宁波市 “3315计划 ”外裔创新人才 申报书（参考样式）Application Form of “3315 plan” for Foreign-Born Creative Talents in Ningbo(Template for Reference)申报项目 Applicant: 专业领域： （ 从填写说明的8个选项中择一填入 ）Area of experti

2、se: (select one from 8options in the “instructions”) 专业方向： Specialty: 用人单位： Employer: 落 户 地： Place of Settlement : 编 号： No: 2申报人姓名 ： Applicant: 电话 ： Telephone: 手机 ： Mobile: 邮箱 ： E-mail: 联系人姓名： Contact Person: 电话 ： Telephone: 手机 ： Mobile: 邮箱 ： E-mail: 填表日期 年 月 日Date of Filling 中共宁波市委人才工作领导小组办公室制Prepa

3、red by the Leadership Office of Experts Work of CPC Ningbo Committee3填写说明Instructions请 登 录 “3315计 划 ”网 上 申 报 系 统 （ 线 注 册 ，按 要 求 填 报 相 关 信 息 和 上 传 附 件 材 料 。Please log in the Online Declaration System of “3315 plan”（ register and fill in the application forms, and upload related certificates and mate

4、rials as required.一、封面I. Cover（一）编号：由网上申报系统自动生成。(II)Number: Automatically generated and filled in by the online application system.（二）申报项目：指申报本计划的项目名称。请填写中、外文名称。例如 “高端氮化物LED材料及芯片关 键技 术” 项目。(III)Project of application: name of the project are applied within this plan. Please fill out in Chinese and E

5、nglish format, For example, “high-end nitrides LED material and chip key technology” project.（三）专业领域：从新材料、高端装备、新一代信息技术、清 洁能源、海洋高技术、生命健康、节能环保、其他等8个选项中择一填入。(IV)Area of expertise: Please select one from 8 options: new material, high-end equipment, new generation of information technology, clean energy,

6、 marine high technology, life excluding the innovation talents of Colleges and unviersities,research institutions.（七）申报人、联系人电话和电子邮箱：联系人应为具体负责该项工作的人员，熟悉申报人、申 报材料的相关情况。联系电话请同时填写 办公电话和手机号码，保 证联系畅通。电 子邮箱应为有效电 子邮箱。(VIII)Contacts of applicant and contact: The contact Person shall be a person responsible f

7、or related work and familiar with the applicant and application materials. Please write both office telephone and mobile phone numbers to ensure contact any time.二、申报书正文4II. Application forms（一）姓名：指申报人的中、外文姓名。请填写中、外文名。(I) Name: Chinese and English names of the applicant. Please write both Chinese an

8、d English names. （二）照片：为近期小两寸正面免冠证件照。请直接制作到申报书电子文档中，并提供单独电子版照片（大小为3.34.4厘米， 300像素/英寸， JPT格式）。(II) Photo: Recently taken two-inch bareheaded and full-faced ID photo. Please directly upload it to the electronic application documents and additionally provide an electronic version. (size: 3.34.4cm, 300

9、pixel/inch, JPG).（三）国籍、出生地及出生日期：国籍指申报人现在的国籍。请填写出生国家、地区。(III) Nationality, Place and date of birth: Current nationality of the applicant. Please write the country or the region.（四）护照号码：填写目前有效的护照号码。(IV)Passport Number: Please fill in the currently valid passport number.（五）联系电话和电子邮箱：是指申报人的固定电话、手机和电子邮箱。

10、(V) Contact telephone/e-mail: The telephone, mobile number and e-mail of the applicant.（六）现任职单位、职务（岗位）及合同时间：填写申报人目前所在单位及担任的职务。合同 时间是指劳动合同中工作期限。(VI) Potential (current) employer, title (post) and contract period: Please specify the current employer and position of the applicant. Term of Contract mean

11、s work period which specified in contract.（七）已获荣誉及职称：根据实际情况选择填写。(VII) Honor / award /title: according to the actual situation to fill out.（八）教育经历和工作经历：请按照从往至今的时间顺序，简要、完整描述申报人的教育和工作经历。每一段经历 均应有明确的起始和终止日期，具体到月份。教育 经历从大学本科填起（博士后属于工作经历）。请写清楚每阶段经历的所在国家、院校、 专业、学位。学位 应同时加注英文。工作 经历请写清楚每 阶段经历的所在国家、单位、职务。单位和

12、职务应同时加注英文。类型为全职、兼职 、访问学者。工作经历中无需描述工作业绩。(VIII)Education and work experience: Please briefly and chronologically specify the applicants education and work experience. It shall include the month/year of starting and the month/year of ending. The education background shall include undergraduate educatio

13、n and above. Please specify country, university, specialty, and degree of undergraduate and above education and add English instructions if necessary. For work experience, please specify country, company and tile, and add English instructions if necessary. Please mark part-time jobs. Work achievemen

14、ts are not required in this item.（九）专长及代表性成果：1、个人专长， 请概述申报人的基本情况、个人专长、研究领域及方向。2、请列出领导（参与）过的主要项目，包括项目的起止时间、项目性质和来源、经费总额、参与人数、申 报人的具体职位和任 务。3、主要成果，请列出最能体现申报人水平的代表性论著（论文），或专利，或 产品，每 类均不超过20项。其中，论著（论文）请列出日期、名称、发表载体、全部作者，通讯作者请用“*”注明；专利请列出保护5期、名称、授权国家、 专利所有人等；产品请标明目前的 产业化程度。4、其他，包括获得的重要奖项、在国际学术组织兼职情况、在重要学

15、术会议上作大会报告或特邀报告情况等。(IX) Expertise and representative achievements: 1. Personal expertise, please briefly specify basic information, personal expertise, research field and interest of the applicant; 2. Please specify key projects which the applicant led or participated in, including the time of starti

16、ng/ending, project nature and source, gross expenditure, number of participants, applicants post and his/her task; 3. Key achievements, please specify representative works (papers), patents and products which best reflect the applicants capabilities; please give no more than 20 items for each catego

17、ry. For works (papers), please specify date, title, where published, all authors, and mark the correspondent author with “*”; for patents, please specify term of protection, name, which country authorizes, patent owner, etc.; for products, please specify the degree of industrialization at present; 4

18、. Others, including important awards, positions taken in international academic institutions, speeches or invited lectures on important academic conference, etc.（十）项目描述及工作设想：包括立项的背景和意义；国内外研究现状和发展趋势、产品市场容量分析；项目主要研究开发内容、技术关键及主要创新点；项目预期目标；项目实施方案、技术路线、组织方式与课题分解；进 度安排；现有工作基础和条件。(X) Work plan: The applica

19、nt shall specify jobs and detailed responsibilities which he/she takes after return to China, including work objectives, key methods, expected contributions, current foundation and team, etc.（十一）竞业禁止协议：申报人是否存在竞业禁止协议，如有请列出。(XI)Non-compete agreement: The applicant has a non-compete agreement or not. I

20、f yes, please specify.（十二）破格内容及理由：如需破格，请列出破格内容并说明破格理由。(XII)Reasons and details of expective admission: If expective admission is allowed, please provide details and reasons of expective admission.（十三）本人承诺：申报人须按申报系统中操作提示，将申报书承诺栏打印后亲笔签名承诺，并将承诺内容与 签名扫描上传至申报系统中（未按上述要求操作，直接使用电子签名， 视作无效）。(XIII) I undertak

21、e that: The applicant shall make promise with signature in the “commitment item” of the application form after print it according to the prompt of the application system，then upload it to the system ( It is deemed invalid if use the electronic signatures directly or does not operate according the ab

22、ove requirements ).（十四）用人单位意见：由用人单位填写。请简要说明：1、推荐申报人的主要理由，重点是申报人对本单位的不可或缺性。2、 对申报人的支持措施，即从用人单位角度，为申报人提供的工作条件，包括工作平台、职务等；以及为申报人提供的生活待遇，包括薪酬、住房等。用人单位应对申报人有关信息进行必要的核实，并 对支持条件做出承诺。推荐理由应避免简单 重复申报人在“专长及代表性成果 ”栏的内容。支持条件应6具体，避免笼统。属于破格推荐的， 请同时说明破格理由。(XIV) Opinions by the employer: Filled in by the employer. P

23、lease briefly specify: 1. Main reasons for recommending the applicant, especially how important the applicant is for the employer; 2. Support measures for the applicant, including work conditions provided by the employer such as work platform and position as well as remuneration, housing and other l

24、iving conditions for the applicant. The employer shall verify the applicants related information and promise the implementation of support measures. Reasons for recommendation shall not be the same as “expertise and representative achievements”. Support measures shall be in details. For exceptional

25、recommendation, please specify reasons.（十五）落户地推荐意见：各地推荐的创新人才，由所在区县（市）、开发区党（工）委组织部牵头相关部门提出意见；请简要说明以下内容：1、对申报材料的审核意见；2、提出推荐理由和当地政府的支持措施。属于破格推荐的，同时填写破格推荐的理由。市直或部省属驻甬有关单位推荐的创新人才，无需填写落户地意见。(XIV) Opinions by recommending institution: For recommendations from local government authorities, the organization

26、department of each county (city)/district, or each development zone shall organize other related departments to give opinions; for recommendations by any municipal authority or provincial authority in Ningbo, it shall be directly filled in by the recommender. Please briefly specify: 1. Approval opin

27、ions on application materials; 2. Reasons for recommendation and support measures by local governments (recommenders). For exceptional recommendation, please specify reasons.7姓 名Name中文chinese外文english性 别Sex国 籍Nationality出 生 地Place of birth出生日期Date of birth19 年(y)月(m) 日(d)护照号码Passport No.固定电话Telephon

28、e电子邮件Email近期小两寸正面免冠证件照片（JPG）Recently taken two-inch bareheaded and full-faced ID photo (JPG)手 机Mobile合同时间Term of contract现任职单位Current employer 职务（岗位）Title(Position)单位地址及邮编Address of current employer已 获 荣 誉 及 职称Honor / award /title 国 内 外 院 士 Academician 正 教 授 或 研 究 员 Professor or Researcher 副 教 授 或 副

29、 研 究 员 Associate professor or associate inves 国 家 千 人 计 划 专 家 Expert of national 1000plan 省 级 海 外 引 才 专 项 计 划 Provincial level of overseas talents introduction开始时间 结束时间 学位(加注英文) 国家 院校 专业Time(from-end) Degree (in C & E) Country University Major教育经历Education（从本科填起undergraduate and above）开始时间 结束时间 国家 工

30、作职务 单位 类型Time(from-end) Country Title (in C & E) Company (in C & E) Type(full-T or Part-T)工作经历Work experience8专长及代表性成果Expertise and Representative Achievements1、主要概况 Introduction个人简要介绍（ 限 300字 以 内 ）： Personal Brief Introduction ( Limited to 300 words or less):项目简要介绍（ 限 300字 以 内 ）： Project Brief Intr

31、oduction ( Limited to 300 words or less )2、申报人个人专长（ 字 数 不 限 ）：Personal expertise:( Words not limited)3、领导（参与）过的主要项目 Key projects the applicant lead (participated)起止时间Started and finished time项目性质和来源Nature and source of the project经费总额Total amount of the funding参与人数Number of participants申报人的具体职位和任务Sp

32、ecific position and task of the applicant9专长及代表性成果Expertise and Representative Achievements4、主要成果（每类均不超过20项） Key achievements (no more than 20 items for each category)（1）论著论文信息Publication Information论著论文名称Publication Name发表载体（出版社）Publication Carrier (Publishing House)论著论文作者AuthorSCI他引（次数）SCI Citatio

33、n (Times)发表时间Publication Time（2）专利（对于PCT申请专利， 请按不同专利授 权国家，分别填写对应专利信息。）Patents (Please fill in the information respectively by authorization country for PCT patents application)专利号Patents Number专利名称Patents Name授权国家Authorization Country专利发明人Patents Inventor专利权人Patentee专利类型Patents Classification是否授权Aut

34、horized (Yes or No)授权（或公告）日Authorization (or Announcement) Date法律状态Legal Status（3）软件著作权Software Copyrights登记号Registration Number软件全称Software Full Name著作权人Author著作权人国籍Nationality of Author登记批准日期Registration Approval Date（4）产品（ 字 数 不 限 ）： Products ( Words not limited)5、其他（ 包 括 获 得 的 重 要 奖 项 、在 国 际 学 术

35、 组 织 兼 职 、在 国 际 学 术 会 议 做 重 要 报 告 等 情 况 ，字 数 不 限 ）Others (including important awards, positions taken in international academic institutions, speeches or invited lectures on important academic conference, etc.)10申报人其他个人信息表Personal Information Request Form申报人： 填表日期： 年 月 日Applicant: Date of Filling: Y

36、 M D关系Relationship姓名Name出生年月Date of Birth国籍Nationality工作单位及职务Employer & Position家庭主要成员及重要社会关系 （配偶、子女、父母，配偶父母、兄弟姐妹）Family Members and Social Relationship (spouse, children, parents of spouse, siblings)国内住址Add.& Postal Code in China国内联系电话Tel. in China国外住址Add. in Home Country国外联系电话Tel. in Home Country电子邮箱 E-mail