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Clinic Assistant Job Interviewforms (1)

This document is a job application form for Klinik Pakar Ortopedik Phang, detailing personal, academic, and employment information required from applicants. It includes sections for personal details, qualifications, employment history, general information, and a declaration statement. Additionally, there are spaces for official use regarding the interview and selection process.

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5 views

Clinic Assistant Job Interviewforms (1)

This document is a job application form for Klinik Pakar Ortopedik Phang, detailing personal, academic, and employment information required from applicants. It includes sections for personal details, qualifications, employment history, general information, and a declaration statement. Additionally, there are spaces for official use regarding the interview and selection process.

Uploaded by

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

DAN
WANITA YANG
NO.48, JALAN TUNKU HASSAN, 70000 SEREMBAN,
NEGERI SEMBILAN DARUL KHUSUS.
TEL: 06-764 3410 FAX: 06-764 3400

POST APPLIED FOR:

1. PERSONAL DETAILS:

FULL NAME: D.O.B.:

NAME IN CHINESE: P.O.B.:

NRIC NO: TEL NO:

OLD I/C NO: H/P NO:

ADDRESS:

SEX/RACE: RELIGION: NATIONALITY:

EPF NO: SOCSO: MARITAL STATUS:

NAME OF SPOUSE: OCCUPATION OF SPOUSE:

NO OF CHILDREN/DEFENDANTS: IN CASE OF EMERGENCY NOTIFY:


(Give name, address & Tel no)

NAME OF ADDRESS:
FATHER:

MOTHER:

2. ACADEMIC QUALIFICATION (In reverse order):


FROM TO
UNIVERSITY/COLLEGE/SCHOOL (YEAR) (YEAR)

PROFESSIONAL (eg. Nursing) /VOCATIONAL/TECHNICAL REG DATE OBTAINED


QUALIFICATIONS etc: NO:
3. EMPLOYMENT TO DATE (In reverse order):

EMPLOYERS NAME & ADDRESS FROM TO POSITION LAST SALARY


(YEAR) (YEAR) GIVEN

4. GENERAL INFORMATION:
a) LANGUAGES/DIALECTS: SPOKEN: ……………………………………………………………………………………………
WRITTEN: ……………....................................................................................................................
b) HOBBIES/INTERESTS: ……………………………………………………………………………………………
c) HAVE YOU ANY ACTIVE INTEREST IN ANY OTHER BUSINESS UNDERTAKING?
IF YES, PLEASE DESCRIBE.
………………………………………………………………………………………………………………………..
d) DO YOU OBJECT TO US CONTACTING ANY OF YOUR PRESENT/PREVIOUS EMPLOYMENT?
YES ( ) NO ( )

e) PRESENT EMPLOYEE (S) OF THIS HOSPITAL WHOM YOU KNOW:


NAME RELATIONSHIP
1. ……………………………………… …………………………………………
2. ……………………………………… …………………………………………
3. ……………………………………… …………………………………………

f) IF OFFERED A POST, WHEN YOU CAN JOIN THE HOSPITAL? ……………………………………………


g) SALARY EXPECTED: ……………………………………………………………………………………………
h) DO YOU SUFFER FROM ANY SERIOUS AILMENT/PHYSICAL HANDICAP WHOSE EFFECTS IMPAIR
YOUR ABILITY TO HANDLE THE JOB YOU ARE APPLYING FOR? IF YES, DESCRIBE.
………………………………………………………………………………………………………………………..
i) HAVE YOU EVER BEEN CONVICTED IN ANY COURT OF LAW, OR DECLARED BANKRUPT OR
DETAINED UNDER THE PROVISIONS OF ANY WRITTEN LAW? IF YES, ELOBRATE.
………………………………………………………………………………………………………………………..
j) WHY APPLY FOR THIS JOB? …………………………………………………………………………………….
k) HOW LONG WILL YOU WORK: ………………………………………………………………………………….
l) ARE YOU LOOKING FOR TEMPORAVARY JOB: ……………………………………………………………...

DECLARATION

I, ………………………………………………………………… hereby declare that the particulars in this


application and any sheets attached are true to the best of my knowledge and belief and that I have not willfully
withheld any material fact. I also understand that if after engagements, it is found that I have deliberately made
a false declaration on the form; the Hospital Authority reserves the right to terminate my service.

DATE: ……………………………… SIGNATURE : ……………………………………….

FOR OFFICIAL USE ONLY:

INTERVIEWED ON: INTERVIWED BY: ……………………………………


SELECTED/NOT SELECTED/KIV …………………………………….
DATE TO COMMENCE: ……………………………………
POSITION: ……………………………………
SALARY/SCALE: ……………………………………
MEDICAL EXAMINATION: ……………………………………

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