Declaration Form For Instructor Revise
Annex A4 (Revised 28 Oct 2013)
DECLARATION FORM FOR INSTRUCTOR
Please answer the following questions by deleting “YES” or “NO” as appropriate.
For any “YES” answers, please provide documentary evidence.
1. Have you ever suffered, or are suffering from any medical condition, illness, disease, mental illness or physical impairment that will render you unfit to provide the services required by the contract?
*Yes/No
2. Have your services as a coach/instructor with any Government School, Government-Aided School, Independent School, Specialised Independent School and Specialised School ever been terminated before the full completion of the contract?
*Yes/No
3a. Do you have a criminal record1 in Singapore? b.Have you ever been convicted in a court of law in any other country for any offence?
*Yes/No
*Yes/No
4. Are you currently being charged with any offence in a court of law in Singapore or in any other country for which the outcome is pending?
*Yes/No
5. Have you received any police warnings in Singapore or in any other country?
*Yes/No
6. Are you under any current police investigations in Singapore or in any other country following allegations made against you?
*Yes/No
7. Have you ever been disciplined by any sporting/arts/professional body in Singapore or in any other country or are you facing disciplinary proceedings by any such sporting/arts/professional body?
*Yes/No
8. Have you ever received any complaints made against you in relation to your professional service in Singapore or in any other country?
*Yes/No
9. Have you been in the employment of the Singapore Civil Service before? If yes, please complete Questions 10 and 11 below.
*Yes/No
10. Which Ministry/Department were you last with before you left the Singapore Civil Service? _____________________________
11. Why did you leave the employment of the Singapore Civil Service?
a. Normal resignation
b. Resignation under Special Resignation Scheme
c. Resignation under
DECLARATION FORM FOR INSTRUCTOR
Please answer the following questions by deleting “YES” or “NO” as appropriate.
For any “YES” answers, please provide documentary evidence.
1. Have you ever suffered, or are suffering from any medical condition, illness, disease, mental illness or physical impairment that will render you unfit to provide the services required by the contract?
*Yes/No
2. Have your services as a coach/instructor with any Government School, Government-Aided School, Independent School, Specialised Independent School and Specialised School ever been terminated before the full completion of the contract?
*Yes/No
3a. Do you have a criminal record1 in Singapore? b.Have you ever been convicted in a court of law in any other country for any offence?
*Yes/No
*Yes/No
4. Are you currently being charged with any offence in a court of law in Singapore or in any other country for which the outcome is pending?
*Yes/No
5. Have you received any police warnings in Singapore or in any other country?
*Yes/No
6. Are you under any current police investigations in Singapore or in any other country following allegations made against you?
*Yes/No
7. Have you ever been disciplined by any sporting/arts/professional body in Singapore or in any other country or are you facing disciplinary proceedings by any such sporting/arts/professional body?
*Yes/No
8. Have you ever received any complaints made against you in relation to your professional service in Singapore or in any other country?
*Yes/No
9. Have you been in the employment of the Singapore Civil Service before? If yes, please complete Questions 10 and 11 below.
*Yes/No
10. Which Ministry/Department were you last with before you left the Singapore Civil Service? _____________________________
11. Why did you leave the employment of the Singapore Civil Service?
a. Normal resignation
b. Resignation under Special Resignation Scheme
c. Resignation under