Dr. Shami Hospital

Surname:	First Name:
Present Address:	Permanent Address:
Home Telephone Number:	Work Telephone Number:

POSITION APPLIED FOR:

Extem
Intern
Resident
House Physician

Age:	Date of Birth:	Place of birth:	Height:	Weight:
Nationality:	Passport No.:	Place of issue:	Date of issue:	Valid until:
SEX: Fem. Male		Marital Status (Please Check): Single Married Widowed Divorced Separated
If you have Children - Please state Ages			If Married - Nationality Of Wife

LEISURE ACTIVITIES / HOBBIES:
Professional Associations you belong to:
Have you performed military service: Yes No Exempt
If So When:	In Which country:	Rank on termination:

EDUCATION AND PROFESSIONAL SCHOOLS
Name of school / University	To	From	Type of course	Certificates obtained

LANGUAGE QUALIFICATION (Please Check)
Languages You Know	Speak			Write			Understand
Languages You Know	Excel	Good	Fair	Excel	Good	Fair	Excel	Good	Fair

EMPLOYMENT RECORD: Please give complete record of all employment held starting with your position
Name & full address of employer	Size & Nature of Business	Position held	Date		No. of-Staff under your Direction	Salary		Reason for Leaving
Name & full address of employer	Size & Nature of Business	Position held	From	To	No. of-Staff under your Direction	Starting	End	Reason for Leaving

Personal References
Name	Address	Position

Are you prepared to sign a contract for?

One Year
Two Years
Three Years

When are you prepared to start?

Minimum salary acceptable:

Do you have any handicaps:

Sight
Hearing
Limbs
Other

Have you had any serious illness Injury Operation (give details):

2 photos
Image size does not exceed 3 MB	Image size does not exceed 3 MB

DECLARATION
It is understood that in case of signing a contract with the hospital, I shall be employed for an initial period of 90 days Training. I certify than all my answers correct, and I declare the hospital unresponsible regarding this matter. The hospital is not obliged to sign a definitive contract with me at the end of the 90 days period, regardles of the state of my answers. I am ready to submit myself for a medical examination

DECLARATION

It is understood that in case of signing a contract with the hospital, I shall be employed for an initial period of 90 days Training. I certify than all my answers correct, and I declare the hospital unresponsible regarding this matter. The hospital is not obliged to sign a definitive contract with me at the end of the 90 days period, regardles of the state of my answers. I am ready to submit myself for a medical examination

Application For Employment of Physicians

Medical Care Center - Dr. Shami Hospital

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Career

Application For Employment of Physicians

Medical Care Center - Dr. Shami Hospital

Hospital News

Site map

Contacts Info