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Employment Application Form Administration 2022

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ST.

JOHN EYE HOSPITAL – JERUSALEM PLEASE


ATTACH
A PHOTO
APPLICATION FORM FOR EMPLOYMENT

ANSWER ALL SECTIONS OF THE FORM JOB APPLIED FOR:


Mr/Mrs/ First Name: Surname Name: Fathers Name:
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? Yes / No Type:

Marital Status: Single / Married / Divorced / Widowed

Have you taken COVID-19 Vaccine? Yes /


No Please give dates

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.

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.

Organization: Organization:

Name: Name:
Position: Position:

Address: Address:

Tel: Tel:
Fax: Fax:
Email: Email:

Form #: ADM/EST/07 Issue No.: 1/1 Issue Date: 14/01/2022


Declaration: All the information given on this form is accurate and true. Failure to provide correct inform

Signed ……………………………………………….. Date …………………………………….

EDUCATION & PROFESSIONAL QUALIFICATIONS

Subject / Qualification Place of Study Grade / Result Year


Obtained

ADDITIONAL TRAINING COURSES ATTENDED

Subject / Qualification Place of Study Grade / Result Year


Obtained

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:
EMPLOYMENT HISTORY
Current or Last
Employer
Address

Type of Business Telephone

Start Date End Date

Job Title & Description of Duties

Reason for Leaving

Form #: ADM/EST/07 Issue No.: 1/1 Issue Date: 14/01/2022


Employer Name 2

Address

Type of Business Telephone

Start Date End Date

Job Title & Description of Duties

Reason for Leaving

Employer Name 3

Address

Type of Business Telephone

Start Date End Date

Job Title & Description of Duties

Reason for Leaving

LANGUAGES

English Arabic Hebrew Other Other

Understand

Speak

Write

Form #: ADM/EST/07 Issue No.: 1/1 Issue Date: 14/01/2022


PERSONAL STATEMENT
Please provide any other supporting information that you think may be helpful in supporting your
application for employment, include abilities, skills, knowledge and experience. Please also tell us
about any voluntary or unpaid activities.

Form #: ADM/EST/07 Issue No.: 1/1 Issue Date: 14/01/2022

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