BUGANDO MEDICAL CENTRE
EMPLOYMENT APPLICATION FORM
To be filled by candidate wishing to join Bugando
Medical Centre.
1. Name in
Full
(Under line the name
you would prefer to be used in addressing you)
2. Post applied for
..
3. Date of birth:
4. Marital Status
. No. of children:
..
5. Nationality:
.
6. Present address:
7. Home Address:
..
(Permanent address)
Village:
Ward:
.District
Region:
.
8. QUALIFICATION
A. Academic
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NAME OF SCHOOL |
YEAR |
TO |
SUBJECT TAKEN |
QUALIFICATION |
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B. University
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NAME |
YEARS ATT. FROM |
TO |
SUBJECT |
QUALIFICATION |
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C. Other Colleges/Training Attended
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NAME OF INSTITUTION |
YEARS ATT. FROM |
TO |
COURSE CONTRANTS SUBJECT |
QUALIFICATION |
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9. Working Experience
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SERIAL NO. |
POSITION |
PERIOD FROM |
TO |
EMPLOYERS AND ADDRESS |
LAST SALARY |
REASONS LEAVING IF APPL. |
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10. Immediate relatives
Fathers Full Name:
Mothers Full Name:
..
Name of Spouse:
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CHILDRENS
NAMES |
DATE OF BIRTH |
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11. Names of direct dependants if any
1
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2
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3
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12. Names of relatives in this organization
if any:-
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NAME |
RELATIONSHIP |
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13. Name and Addresses of three referees
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NAME |
ADDRESS |
POSITION |
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14. Reasons for wishing to join this
organization:
..
...............
..................................................................................................
15. If employed give your three major
expectations from:
(1)
..
(2)
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(3)
..
16. HOBBIES
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TYPE OF HOBBY |
MAJOR TEAMS/GROUPS PARTICIPATED |
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17. (1) Have you ever been involved in any
Police investigation?
Yes/No
(2)
If yes, what was the cause/Nature of investigation?
..
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(3)
Have you ever been involved in a criminal offence
Yes/No
(4)
If yes, what was the nature of offence?
(5)
...
18. PROFESSIONAL
MEMBERSHIPS/REGISTRATION
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INSTITUTION/BODY AND ADDRESS |
TYPE OF MEMBERSHIP |
YEAR OF REGISTRATION |
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19. Given
the opportunity to join us, will you at all times subordinate your own interest
to
the centre interest?
Yes/No.
20. If
selected for employment, will you abide to both professional ethics and working
rules?
and regulations. Yes/
No.
21.(a) What are the things you like most in your
field of work/profession
.
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(b)
What are the things you like least in your field of work/profession?
.
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22. What is
the initial salary expected?
..
23. Why do
you specifically like to join us?
.
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24. What
languages can you?
(a) Speak Fluently?..........................................................................................................
(b)
Speak, write and read fluently?..................................................................................
I have observed all the conditions above and the
information given is truth to best
of my knowledge.
Date:
. Signature:
.
Name: