Aber Care Application Form 7
1 Thomson Road, #04-346G, S300001 | www.Abercare.SG |  DID 6721 9231
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Position Applied ( Staff Nurse /Nursing Aide / Healthcare Assistant /other) *
First and last name
Name *
First and last name
Passport Number *
First and last name
Nationality *
Gender *
Date of Birth*
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Religion
Weight *
Height *
Language Proficiency ( Spoken)
Language Proficiency ( Written)
Marital Status
Mobile number *
Email *
Highest Qualification? *
Registered with Singapore  Nursing Board ? *
Registered with Nursing Board of your country ? *
Are you Currently Employed in Singapore *
Required
When is your contact going to end if you are currently working in singapore ( Month/Day / Year)
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Work experience 1 *
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 2 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 3 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 4 ( if applicable )
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 5 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 6 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
1. Have you ever been dismissed or discharged from the service of any company? *
2. Have you been convicted, or been the subject of an inquiry or an investigation by any professional body, licensing or health authority in Singapore or elsewhere? *
3. Have you ever been convicted in a court of Law in any country? *
4. Have you suffered, or are suffering from any physical impairment or disease including mental illness, deafness, handicap, etc?               *
5. Are you an undischarged Bankruptcy?   *
If yes for Question 1 to 5, please specify
6.    I consent to the collection, use and/or disclosure of your personal data by Aber Care Pte Ltd for the purposes of (a) assessing and evaluating your suitability for job placement with the client and/or other employers and/or potential employers, (b) verifying your identify and the accuracy of your personal details and other information provided, and (c) disclosing your personal data to the client and/or other employers and/or potential employers for them to assess and evaluate your suitability for employment and to verify your identity and the accuracy of your personal details and other information provided. *
Signature
Date
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