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To:
COMMANDANT, NCDCC
ATTN: Head Operations NCDCC
HQ National Civil Defence Cadet Corps (NCDCC)
c/o Home Team Academy
501 Old Chua Chu Kang Rd
Block 12B #01-82
Singapore 698298
Fax: 6465 3551
Paste Passport
size colored
photo
APPLICATION FORM
FOR NCDCC CADET LIEUTENANT
SECTION A
APPLICANT’S PARTICULARS
Please fill in your particulars below in BLOCK LETTERS. All fields are necessary.
Name:
(as in NRIC)
NRIC/FIN/Passport*
No.:
Date
Birth:
of
Race:
Religion:
DD /
YYYY
Postal
Code:
Address:
Home
Contact
No.:
MM
Mobile
Contact No.:
Email
Address:
1
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/
Gender*:
M / F
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SECTION B
EDUCATION DETAILS
Please fill in the details below in BLOCK LETTERS. All fields are necessary.
Secondary
School:
Course
Study*:
of
Sec 4 / 5
Special / Express / Normal (Academic) / Normal (Technical)
Position(s)
Held:
CCA(s):
Membership
of
Clubs/
Societies
/
Youth
Organization
s*:
SECTION C
YES / NO (If yes, please specify)
NCDCC DETAILS
To be filled by NCDCC cadets. Please fill in the details below in BLOCK LETTERS.
Rank:
Passed CD
Knowledge
Test*:
YES / NO
NCDCC
Courses
Attended:
SECTION D
UNIFORMED GROUP DETAILS
To be filled by non-NCDCC cadets, if applicable. Please fill in the details below in BLOCK
LETTERS.
Uniformed
Group:
Rank:
NCC / NPCC / Others (please specify):
Appointment(s)
Held:
Courses
Attended:
2
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SECTION E
PROFICIENCY QUESTIONNAIRE
Please answer the following questions.
Outdoor Interests /
Hobbies / Sports:
NAPFA Test
Result*:
Ability to swim 50m
without aid*:
Year before: Gold / Silver / Bronze / Fail
Current year: Gold / Silver / Bronze / Fail
YES / NO
Fear of
Confined
Spaces*:
YES / NO
Rate your involvement in the following activities from 0 to 5: (0 = None, 5 = Frequent)
Swimming:
Kayaking:
Running/Jogging:
SECTION F
Camping:
Rock-Climbing:
NEXT-OF-KIN PARTICULARS
Please fill in your next-of-kin’s particulars below. All fields are necessary.
Name:
Relationship
to Applicant:
NRIC / FIN /
Passport* No.:
Address:
(if different from
Applicant)
Postal Code:
Home
No.:
Mobile
No.:
Contact
3
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Contact
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SECTION G
DECLARATION & CONSENT
Declaration & Undertaking
I declare that all information furnished in Section 1 is true to the best of my knowledge and that I
have not willingly suppressed any material facts.
I shall comply with the Rules and Regulations of the Course, which includes no smoking and
consumption of alcoholic drinks and drugs. I shall also fully co-operate with the Instructors and
Staff of HQ HTCC, HQ NCDCC and the Civil Defence Academy. I shall exercise proper conduct
and fulfill the responsibilities expected of a Cadet Officer.
Furthermore, I am aware that my eventual posting as a Cadet Lieutenant would ultimately be
decided by HQ NCDCC. I shall faithfully serve my duties as a Cadet Lieutenant regardless of my
posting, which may not be my previous unit.
Name of Applicant:
Contact No:
Signature of Applicant
Date
Acknowledgement & Consent
I,
_______________________,
parent
/
guardian*
of
_______________________
(NRIC/FIN/Passport* No.: ________________) hereby:
1. Support / do not support* to my child / ward in his / her interest to attend the Cadet Lieutenant
Course from ______________________ to ______________________.
2. Give approval for my child / ward to enrol and participate in all activities during the Cadet
Lieutenant Course from ______________________ to ______________________.
3. Certify that I am not aware of any known medical conditions which may prevent my child /
ward from participating actively in all NCDCC activities. If there is any medical condition that
you would like us to know, please state it below.
Existing Medical Condition:
4. I am willing to bear the cost of any loss of or damage to the uniform and equipment (other than
through legitimate wear and tear) issued to my child/ward.
Name of Parent/Guardian:
Signature of
Parent / Guardian*
Contact No:
Date
4
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SECTION H
RECOMMENDATION BY NCDCC OC UNIT / BRANCH HEAD
1. I recommend / strongly recommend* _______________________________ to attend the
NCDCC Cadet Lieutenant Course.
Remarks:
Please note that upon successful completion of the Cadet Lieutenant Course, the trainee can be
posted to/out of your unit under the discretion of HQ NCDCC.
Rank/Name of OC
Unit/Branch Head:
Signature/Stamp of
OC Unit/Branch Head*
Designation*:
NCDCC
OC Unit / Branch Head
Contact
No:
Date
School: ___________________________ / HQ
5
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Annex B
The Commandant
National Civil Defence Cadet Corps
c/o Home Team Academy
501 Old Choa Chu Kang Road
Singapore 698928
Fax:
Tel:
Attn:
6314 6768
6314 6729
Head Human Resource HTCC
RE: Confirmation of Cadet Lieutenant
Part I: Personal Particulars
Name of P/CLT:
CLT Course:
NRIC No.:
Dec
Batch:
Date of Appointment :
/
Email:
Home Address:
Home/HP:
NCDCC School Unit attached to:
Area:
Institution currently studying in:
Expected year of graduation:
I,
of NRIC
(name of P/CLT)
hereby state that I have completed the minimum requirements for confirmation to the rank of Cadet Lieutenant. All
entries in the Cadet Lieutenant Duty Record Form (Probation) have been duly completed and verified by the
respective Officer-in-Charge of the activity/ event.
Signature of P/CLT
Date
Part II: Recommendation by OC Unit
 Recommended for Confirmation to the Rank of CLT
 Not Recommended for Confirmation to the Rank of CLT
If not recommending for confirmation, please state reasons:
Rank/Name/Signature of OC Unit
_______________
Date
6
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Unit Stamp
S/N
Date
Duration (Days)
Role
Category
TOTAL POINTS:
Signature of Approving
Officer
Effective Period: __________________ to __________________
P/CLT to CLT Activity Record (6 months)
Name: ______________________________
Activity
Vetted by (Rank/Name/Signature): __________________________________
Points
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Annex C
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Annex C
S/N
Date
Duration (Days)
Role
Category
TOTAL POINTS:
Signature of Approving
Officer
Effective Period: __________________ to __________________
CLT to S/CLT Activity Record (12 months)
Name: ______________________________
Activity
Vetted by (Rank/Name/Signature): __________________________________
Points
8
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Annex D
CADET LIEUTENANT SERVICE POINTS SYSTEM
Category
Nature of Duty
A
Skill Certification Course
Participant
Examples
1-Man CPR & AED Instructor
Course, L1 Sports Climbing, 2Star Kayaking
A
Experiential Course/ Event
Participant
Fire-fighting Course, Parades &
trainings, General Meeting,
NCDCC Workplan Seminar
A
National-level Parade
Command Appointment
Holder
A
National-level Competition
or Event Representative
B
Instructors
B
Assistants
C
Planning Committee/
Special Project (OIC/ 2IC)
C
Planning Committee/
Special Projects (Other key
members)
Parade/ Contingent Commander
(incl. Reserve) for SYF, NDP,
NCDCC Day Parade
Inter-UG Bowling Competition,
Inter-UG Adventure Race
Unit Training, CPR Course,
ATC, SNCO Course
SCDF Workplan Seminar,
Home Team Convention, Course
Closing Ceremony
UACDC Committee OIC, Sector
OSCAR 2IC,
Sectorised Training OIC
UACDC Logistics OIC,
Sectorised Training Committee
Member
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Points Awarded
3 per day
3 per day
+3 per day
+3 per day
5 per Day
7 per Day + Night
5 per Day
7 per Day + Night
HQ Level: 25
Sector Level: 15
Unit Level: 10
HQ Level: 15
Sector Level: 10
Unit Level: 5