APPLICATION FOR
REGISTRATION AS TRAINER
FOR COURSES AT
COMMUNITY CENTRES /CLUBS (CCs) AND
RESIDENTS’ COMMITTEE (RC) CENTRES
This form will take you about 20 minutes to fill in
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
Doc. 1 (21 March 2017)
APPLICATION FOR REGISTRATION AS PEOPLE’S ASSOCIATION (PA) TRAINER FOR COURSES
AT COMMUNITY CENTRES / CLUBS (CCs) AND RESIDENTS' COMMITTEE (RC) CENTRES
Note:
1. To help us with your application, please complete the form in full and indicate 'NA' for areas that are not applicable and
provide an attachment if space is insufficient.
2
Application will not be considered or will be delayed if the following are not submitted.
 A recent, coloured passport-sized photograph onto the application form that will be used for issuance of PA Trainer Card
upon successful approval as PA Trainer. Photo to be of 35mm wide by 45mm high without Border and with resolution of
400 by 514 pixels taken with white background.
 A photocopy of your NRIC (for Singaporean / Permanent Resident) or FIN Card (for Foreigners)
 Relevant certificates and supporting documents as indicated in your application form.
 A clearly written profile (Part VI of application form)
 A clearly written course proposal form (Annex)
3. Please send the completed application form by post to the People’s Association, c / o Lifeskills & Lifestyle Division,
Policy & Administration Section, 9 King George’s Avenue, Singapore 208581
4. We regret that only shortlisted candidates will be notified.
Proposed Course(s) To be Conducted at CC / RC Centre
(e.g. Chinese Calligraphy, Japanese Language, Piano, etc.)
(a) ________________________________________________________________________
(b) ________________________________________________________________________
(c) ________________________________________________________________________
I
Please Affix
A Recent
Passport Size
Photograph
(Specifications
according to
paragraph 2)
PERSONAL PARTICULARS
Name (as in NRIC or passport, please underline surname)
* Dr / Mr / Mrs / Mdm / Ms
Name in Chinese Characters
Date of Birth
Sex
*Male /Female
NRIC No. (*Pink / Blue)
Nationality
Marital Status
*Single / Married /
Divorced / Widowed /
Separated
Race
*Chinese / Malay / Indian /
Eurasian
FIN No. & Expiry Date
Country of Birth
Others (please specify)
Residential Address
Occupation
(if applicable)
Type of Pass
*Employment / Dependent
Others (please specify)
Contact Nos.
Home ____________________________________
Postal Code (
)
*Handphone _______________________________
E-mail Address _____________________________
* Delete as necessary
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
Doc. 1 (21 March 2017)
2
II
MEDIUM OF INSTRUCTION
A Trainer can indicate more than one medium of instruction when he or she is highly proficient in more than one language and
wants to offer courses using different mediums of instruction, e.g. Abacus (in English), Abacus (in Chinese).
If English is indicated as the medium of instruction, the Trainer must be highly proficient in English and conduct the courses in
English only.
Please tick the appropriate box
English
Chinese
Malay
Tamil
Others (please specify)
(eg French, Japanese, etc.)
III
CURRENT EMPLOYER’S DETAILS
Name & Address of Employer
Office Contact Nos.
Tel. No.
Postal Code (
IV
Fax No.
)
DETAILS OF QUALIFICATIONS (please attach relevant certificates / documents)
Academic Qualifications
S / No.
Highest Academic Qualifications Attained
Name of Institution / Examination Board
[e.g. Bachelor of Arts, PhD (Finance), etc.]
Year
From
To
Relevant Professional Qualifications
S / No.
Course Attended
(e.g. Yoga Instructor Course)
Qualifications Obtained
(e.g. Yoga Instructor Certificate)
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
Name of Institution /
Examination Board
Year
From
To
Doc. 1 (21 March 2017)
3
V
RELEVANT EXPERIENCE IN TEACHING OR AWARD(S) RECEIVED (please attach relevant certificates / documents)
Relevant Experience in Teaching
(please attach references and comments from previous course participants where possible)
S / No.
Course(s) Conducted
(e.g. Yoga – Beginner, Intermediate and
Advanced Level)
Name of Organisation
From
To
(CC or RC or other private organisation)
(mm / yy)
(mm / yy)
(e.g. YMCA)
Relevant Award(s) Received
S / No.
Recognition(s) / Award(s) Received
Year
Name of Event / Organiser
From
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
To
Doc. 1 (21 March 2017)
4
VI
PLEASE PROVIDE A PROFILE OF YOURSELF IN ABOUT 50 WORDS.
(this information will be used at our discretion to market your services to the CCs and RCs, and to the public
through our on-line course registration services and other marketing purposes)
Important Note : Applications will not be considered or will be delayed if a proper, clearly written profile is not
provided. When writing your profile, please state your
 Professional qualification
 Experience in teaching
 Awards / Accreditation Attained
Sample Profile:
Nancy Lee is a well-known trainer in the spa industry. She holds a CIDESCO diploma. She
developed her knowledge of spa therapies over the years and is now passionate about the
subject, especially on Healing and Water Therapy. She has appeared on Channel NewsAsia
and local variety shows to talk about and demonstrate her massage techniques. Her bubbly
and warm character enables her to bond with her participants.
Self Profile (to be typewritten)
VII
MEDICAL & PERSONAL DECLARATION
Please answer the following questions and tick the appropriate box
(the information declared will not automatically disqualify applicants from being shortlisted)
1) Have you ever suffered, or are suffering from any medical history of pulmonary, nervous
or mental health conditions, prolonged ill health, or impediment in speech or hearing or
any physical impairment?
Yes
No
2) (a) Do you have a criminal record1 in Singapore ?
Yes
No
Yes
No
(b) Have you ever been charged or convicted in a court of law in any other country?
1.
3) Have you ever been suspended, discharged or dismissed from the service by
any employer?
Yes
No
2.
4) Have you ever applied to be, or have been a PA’s Trainer?
Yes
No
3.
5) Are you an office bearer or member of any of the PA’s Grassroots Organisations?
Yes
No
6) Are you related to any office bearer or member of any of the PA’s
Grassroots Organisations?
Yes
No
7) Are you a pre-qualified private operator of the PA?
Yes
No
If your answer is “Yes” to any of the above, please provide brief factual information and documents (where relevant)
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
1-
By this, we refer only to a criminal record of a conviction under the Registration of Criminal Act
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
Doc. 1 (21 March 2017)
5
VIII
DECLARATION
I hereby declare that all information provided is true and correct; and agree to abide and be bound by the Terms and
Conditions of the PA, Community Club Management Committees, other PA Committees and Organisations amended and
updated from time to time and also all legal duties imposed upon me by law whether statutory or common law or otherwise;
and authorise the PA to disclose my personal information to its employees, service providers, vendor and affiliated partners
and such other person(s) or agency who is reasonably deemed to have a legitimate interest in such information . I
understand that if I have suppressed any material fact or given false information, the PA shall have the right to terminate my
services as a Trainer without prejudice to any of their other rights for damages and/or losses and/or indemnities against me
for my breach of contract or failure to fulfil the full term of their contract as a result of the termination.
I am also fully aware and accept that I would be from time-to-time subject to the necessary audits by the relevant
government and / or investigative authorities and / or appointed agencies under the normal procedures and policies of the
PA and / or the Singapore Civil Service. I am aware and undertake to comply fully with such necessary audits and
acknowledge that my failure to render assistance in or to clear such audit would be tantamount to me breaching the terms of
engagement and PA shall have the right to immediately terminate my services as a Trainer, again without prejudice to any of
their other rights for damages and/or losses and/or indemnities against me for my breach of contract or failure to fulfil the full
term of their contract as a result of the termination.
I also understand that my services as a PA Trainer will be tied to the validity of my employment status / papers in Singapore
and obtaining, if so necessary, the approval from the Immigration and Checkpoint Authority, Ministry of Manpower or all such
other relevant government agencies.
Further, I also fully understand and accept that I may be required to commence teaching and / or instructing in and / or
continue in the proposed and / or existing course before the information (and / or any updates) provided by me are fully
verified by the PA, which may eventually prove adverse and / or unfavourable to me, and / or that the result(s) of such audits
carried out from time-to-time may prove adverse. In such an event or circumstance(s), I fully agree and accept that the PA
shall be fully entitled at its sole discretion to terminate the provision of teaching and / or instructional services with immediate
effect, without prejudice to any of their other rights for damages and/or losses and/or indemnities against me for my breach
of contract or failure to fulfil the full term of their contract as a result of the termination.
Signature of Applicant
Date
FOR OFFICIAL USE
Application Form Received Date
Application ID No.
* Delete as necessary
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
PA /TD /01 /2003
Doc. 1 (21 March 2017)
6
Annex
COURSE PROPOSAL FORM
Note: Please use a fresh form for each course to be offered.
Applications will not be considered or will be delayed if a proper typewritten course proposal is not provided.
PROPOSED COURSE DETAILS
Course Title
Medium of Instruction
Target Group
(please state age range for children's
courses)
No. of Session(s)
No. of Hour(s) per Session
No. of Participants per Class
Minimum
Maximum
Brief Description of Course
(please use not more than 200 words. The information will be used for publicity and marketing purposes)
 Background and history of the subject
 Course Content / Syllabus (please provide separate attachments if necessary)
 Teaching Methods
 Materials to be purchased / given
Sample Course Proposal 1
Aikido is a modern, non-violent and non-competitive Japanese martial art of self-defense. Besides being a means of workout and character development, Aikido also emphasises proper etiquette, self-discipline and a spirit of respect for fellow
human beings.
There will be a 15-minute warm-up at the beginning of each training session. After the warm-up, the Trainer will
demonstrate basic Aikido techniques and student will then partner each other to practise. After some basics, the Trainer
may split the class up into the different grades to train related techniques. Towards the end of the class, throw exercises are
done in groups for students to practise falling and experience a variety of training partners. Sometimes, free throw
exercises are also done to train student’s reaction when being attacked by one or even more attackers. At the end of the
class, a breathing extension exercise is usually done in a seating position with a partner.
All-white training jacket and pants with belt is the basic attire for Aikido. As beginners progress, they will change from white
belt to various coloured belts to indicate their grades.
Sample Course Proposal 2
Pilates is a method of exercise developed by German-born Joseph Pilates in the 1920s, which consists of various physical
movement programs designed to stretch, strengthen, and balance the body. It is a low-impact exercise which focuses on
postural symmetry , breath control, abdominal strength, spine, pelvis and shoulder stabilization, muscular flexibility, joint
mobility and strengthening through the complete range of motion of all joints.
A typical 1-hour mat work training session starts with fundamental movements like breathing and gentle spine exercises to
warm up the body. This is followed by 40 minutes of mat work movements and finally 5 to 10 minutes of relaxation (warm
down) to end the class. The trainer will demonstrate and explain each movement and move among the participants to
ensure proper technique and assist as necessary.
While practising Pilates, you will require:
(i) A folded towel, blanket or exercise mat of adequate thickness and density to place on the floor for protection of your
spine;
(ii) A long towel or stretchy rubber exercise band; and
(iii) A flat cushion or small folded towel to place under your head, if necessary.
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
Doc. 1 (21 March 2017)
7
Course Proposal (To be typewritten. Please use additional sheets if necessary)
PROPOSED COURSE FEES, MATERIAL FEE & MINIMUM HONORARIUM AMOUNT EXPECTED BY TRAINER



Trainers are paid an honorarium for their services.
The honorarium is based on a percentage of total course fee collection (course fees charged less GST x no. of participants).
The course fees would be negotiated and determined by the CC / RC, based on the qualifications of trainer, market supply and
demand for courses, and local market conditions.
Proposed Course Fee
Minimum Honorarium Amount Expected by Trainer
Material Fee
(if applicable)
Full course fee
S$
Per hour course fee
S$
Full honorarium
Per hour honorarium
S$
S$
Name
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE
S$
Signature & Date
Doc. 1 (21 March 2017)
8