DARACH ASSOCIATE AND MARKETING CONSULTING
NIGERIA LIMITED
EMPLOYMENT APPLICATION FORM
Kindly complete this by typing or printing in ink. Incomplete or unsigned
application will not be considered.
Personal Data
Name: ---------------------------------------------------------------------------------------------------
Date of Birth: ------------------------------------------------------------------------------------------
Email Address: ……………………………………………………………………………………………………….
Residential Address:----------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
Phone Numbers 1) -------------------------------- 2) ---------------------------------
Education (Academics) Begin with highest qualification
Institution Discipline From – To Grade (Class)
1)
2)
3)
Professional Qualification (if any): --------------------------------------------------------------
Work Experience (List most recent work experience)
Company’s Name & Address: -----------------------------------------------------------------------------
----------------------------------------------------------------Tel No: --------------------------
Job Title: ------------------------------------------------------------------------------------------------
1
Date employed ----------------------------- to ----------------------------------------------
Name of Immediate Supervisor/ Phone Number: --------------------------------------------/
-------------------------------
Job Description (Duties, skills, equipment used, achievement etc)
If you have left kindly state reasons for leaving (Please tick)
Dismissal ---- Termination --- Resignation--- Please state any other
Previous Work Experience
Company’s Name & Address: __________________________________________
Job Title: ___________________________________________________________
Date employed______________________ To _____________________________
Name of Immediate Supervisor:________________________ Tel No:________
Reasons for leaving (Please tick)
Dismissal ---- Termination --- Resignation--- Please state any other
2
Additional information that could help you qualify for this position
List References
Name Company Designation/Dept Referee Tel
General Information
Do you have any health problem? Yes _____ No _____
If yes, please state the health issue ________________________________________
Which industry will you not be willing to work? ______________________________
Are you willing to work in any other state other than your state of residence? Yes __ No ___
Have you ever be convicted for criminal charges? ____________________________
Are you computer literate? Yes _____ No _____
Please state computer applications that you have practical knowledge of
_____________________________________________________________________
Notice required by present employer ______________________________________
What is your current salary?-------------------what is your expected Salary?----------------
3
If we or our client is unable to pay the expected amount should we still call you for further
negotiation? Yes _____ No _____
___________________________________________________________________
The information that you provided on this application is subject to verification. Falsification
or misrepresentations may disqualify you from consideration for employment, or if hired
may be a ground for termination at a later date. Please note that we may not inform you
before we contact your present or past employer.
____________________________________________________________________
With my signature below ( Name, typed or hand written), I certify that all information on
this and all pages is true, correct and complete to the best of my knowledge and contains no
deliberate falsifications or misrepresentation. I authorize all former employers, schools to
release job and academic related information they may have about me and I release all
persons or companies from any liability or responsibility for providing such information.
_______________________ ______________ _____________
Name Signature Date
