www.drsulaimanalhabib.

com

NURSING APPLICATION FORM

TO BE FILLED BY THE CANDIDATE

REF. NO..

1. Full Name: _________________________________________________________

2. Sex / Date of Birth: __________________ / ____________________________
3. Nationality: ________________________ Height: ________ Weight: _________
Recent
4. Marital Status / No of dependents: ________________ / _______________
Photo
5. Position Applied For: ________________________________________________
6. Date available: _____________________________________________________
7. Summary of Qualification(s):
COLLEGE DEGREE

SPECIALTY

YEAR
OBTAINED

PLACE OBTAINED

8. Professional Licensure:
Year Obtained: ______________ Rating: _________________
9. Work Experience in Hospitals/ Medical Centers:
PERIOD
OF
EMPLOYME
NT

POSITION

HOSPITAL/CLINIC

FROM (MO./YR) - TO
(MO./YR)

HOSPITAL
BED
CAPACITY

ASSIGNED
AREA

10. Additional Information (Assigned Area).

i) NICU:
No. of Incubator________________ No. of
Ventilator________________
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BED
CAPACITY IN
ASSIGNED
AREA

ii) DELIVERY ROOM: No. of Cases per month in the

Unit_______________________________
iii) OR / RECOVERY:
No. of cases per day
___________________________________________
11. Contact Numbers with best time to contact:
__________________________________________
12. Email
Address:__________________________________________________________________
13. Contact References:
Name _____________________ Position: ______________Mobile ___________ email
_______
Name _____________________ Position: ______________Mobile ___________ email
_______
Name _____________________ Position: ______________Mobile ___________ email
_______
14. How did you know about HMG? ___________________________________________

Candidates Signature ______________________

Date_____________

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Note: Please fax or e-mail this form within seven working days to:
Fax No: 00966 1 4646136
e-mail; recruitment@hmc.com.sa

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