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Application-Form-Nursing

The document is an application form for employment at St. John Eye Hospital in Jerusalem, specifically for nursing positions. It requires personal information, education and professional qualifications, employment history, and references, along with a declaration of the accuracy of the provided information. Additionally, it includes sections on COVID-19 vaccination status, computer skills, and accommodation needs.

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nassermajd39
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17 views

Application-Form-Nursing

The document is an application form for employment at St. John Eye Hospital in Jerusalem, specifically for nursing positions. It requires personal information, education and professional qualifications, employment history, and references, along with a declaration of the accuracy of the provided information. Additionally, it includes sections on COVID-19 vaccination status, computer skills, and accommodation needs.

Uploaded by

nassermajd39
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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ST.

JOHN EYE HOSPITAL – JERUSALEM


PLEASE
ATTACH A
PHOTO
APPLICATION FORM FOR EMPLOYMENT
NURSING
ANSWER ALL SECTIONS OF THE FORM JOB APPLIED FOR:
__________________________

Mr/ First Name: Surname Name: Fathers Name:


Mrs/
Miss/
Dr
Address: Telephone:

Mobile Telephone:
Email:

Date of Birth: In what country were you born:

What is your nationality – as given on your birth certificate / passport:

Identity Card No: Type: Jerusalem / West Bank /


Gaza

Do you have an international passport? Type:


Yes / No

Marital Status: Single / Married / Divorced / Widowed

Have you ever been convicted of any criminal offence? Yes / No


Please state details

This information will be treated with the strictest of confidence.

Are you related to any member of the Hospital staff. Please give details.

Have you taken COVID-19 Vaccine? Yes / No


Please give dates

References: Details must be given of two references, at least one must be


your current or last employer. They MUST NOT be a family member.
YOU MUST INCLUDE A TELEPHONE & FAX NUMBER.

Form #: ADM/EMP/06 Issue No.: 1/1 Issue Date: 14/01/2022


Organisation: Organisation:

Name: Name:
Position: Position:
Address: Address:
Tel: Tel:
Fax: Fax:
Email: Email:

Declaration: All the information given on this form is accurate and true.
Failure to provide correct information may result in future employment
being terminated.

Signed ……………………………………………….. Date


…………………………………….

EDUCATION & PROFESSIONAL QUALIFICATIONS

Subject / Qualification Place of Study Grade / Result Year


Obtaine
d

NURSING EDUCATION

Subject / Qualification Place of Study Grade / Result Year


Obtaine
d

ADDITIONAL TRAINING COURSES ATTENDED

Subject / Qualification Place of Study Grade / Result Year


Obtaine
d

Professional Registration: Please state your Nursing license number.

Form #: ADM/EMP/06 Issue No.: 1/1 Issue Date: 14/01/2022


Palestinian License No.: Expiry Date:
Israeli License No.: Expiry Date:
NMC License No.: Expiry Date:
Other:
Please state what computer skills you have and what packages you can
use:

Do you have a valid driving license? Yes / No


Please state type:
Do you have any convictions on your driving license? If yes please state
details:

ACCOMODATION

Single student accommodation is available for a reasonable charge at the


hospital residents home.
Do you need accommodation? Yes / No

EMPLOYMENT HISTORY

Current or Last
Employer
Address

Type of Telepho
Business ne

Start Date End


Date
Job Title & Description of Duties

Reason for
Leaving

Employer
Name 2

Address

Type of Telepho
ne
Form #: ADM/EMP/06 Issue No.: 1/1 Issue Date: 14/01/2022
Business

Start Date End


Date
Job Title & Description of Duties

Reason for
Leaving

Employer
Name 3
Address

Type of Telepho
Business ne
Start Date End
Date
Job Title & Description of Duties

Reason for
Leaving

LANGUAGES

English Arabic Hebrew Other Other

Understand
Speak
Write

Please write in the space below why you want to attend the Nursing
Course (if applicable). How will you use this course in your nursing
career?

Form #: ADM/EMP/06 Issue No.: 1/1 Issue Date: 14/01/2022


Please provide any other supporting information that you think may be
helpful in supporting your application for employment.

Form #: ADM/EMP/06 Issue No.: 1/1 Issue Date: 14/01/2022

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