Please insert a clear
passport type
photograph in this
box.
N.B. All information provided on the CV template / Application form must be correct and truthful. To provide false or
incorrect information on the CV template can result in your application being withdrawn, or if you have been
recommended for a job, your contract or offer being rescinded.
Personal Profile
Full Name (as per I.C.):
Current NMBI Status on your application:
Date NMBI Decision Letter Issued:
Nationality:
Current Location:
Years of Experience:
Date of Birth:
Phone Number and whatsapp number if different:
Address:
OET / IELTS Results
Reading
Test undertaken OET or IELTS: Date OET / IETLS Sat:
Writing
OET / IETLS expiry date:
Listening
Speaking
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
Education/Qualifications
Date Qualification Obtained Qualifications Obtained/ Name of College
(MM/YY – MM/YY) (Qualification, Name of College)
Registration with Professional Bodies
Duration of Registration
Registration Body Registration Obtained Registration No.
(MM/YY – MM/YY)
Employment History
Current Employment
Date Employed
MM/YYYY - MM/YYYY
Position employed in
Department employed in
Have you been permanent in this
department for the dates listed
above?
Have you worked in other
departments during this
employment? If yes, please provide
full details below.
Hospital Name and Address
JCI Accredited – Answer Yes or No
NABH Accredited – Answer Yes or
No
No. of beds in Hospital
Please note employment cert will be required to reflect the above information.
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
If you have worked in any other clinical departments during this employment, please provide full details of each unit, what
clinical department was it, how many shifts were completed in each unit and the exact dates in each unit.
Description of Unit: Bed numbers, staff to patient ratios etc
Cases handled and specific additional skills i.e. (e.g., team lead / manager, mentorship quality/audit, pain
management etc.):
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
Previous Employment
Date Employed
MM/YYYY - MM/YYYY
Position employed in
Department employed in
Have you been permanent in this
department for the dates listed
above?
Have you worked in other
departments during this
employment? If yes, please provide
full details below.
Hospital Name and Address
JCI Accredited – Answer Yes or No
NABH Accredited – Answer Yes or
No
No. of beds in Hospital
Please note employment cert will be required to reflect the above information.
If you have worked in any other clinical departments during this employment, please provide full details of the unit, how
many shifts were completed and the dates here
Description of Unit: Bed numbers, staff to patient ratios etc
Cases handled and specific additional skills i.e. (e.g., team lead / manager, mentorship quality/audit, pain
management etc.):
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
Date Employed
MM/YYYY - MM/YYYY
Position employed in
Department employed in
Have you been permanent in
this department for the dates listed
above?
Have you worked in other
departments during this
employment? If yes, please
provide full details below.
Hospital Name and Address
JCI Accredited – Answer Yes or No
NABH Accredited – Answer Yes or
No
No. of beds in Hospital
Please note employment cert will be required to reflect the above information.
If you have worked in any other clinical departments during this employment, please provide full details of the unit, how
many shifts were completed and the dates here
Description of Unit: Bed numbers, staff to patient ratios etc
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
Cases handled and specific additional skills i.e. (e.g., team lead / manager, mentorship quality/audit, pain
management etc.):
Date Employed
MM/YYYY - MM/YYYY
Position employed in
Department employed in
Have you been permanent in this
department for the dates listed
above?
Have you worked in other
departments during this
employment? If yes, please provide
full details below.
Hospital Name and Address
JCI Accredited – Answer Yes or No
NABH Accredited – Answer Yes or
No
No. of beds in Hospital
Please note employment cert will be required to reflect the above information.
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
If you have worked in any other clinical departments during this employment, please provide full details of each unit, what
clinical department was it, how many shifts were completed in each unit and the exact dates in each unit.
Description of Unit: Bed numbers, staff to patient ratios etc
Cases handled and specific additional skills i.e. (e.g., team lead / manager, mentorship quality/audit, pain
management etc.):
Gaps in Employment
Date Attended
Reason
(MM/YY – MM/YY)
Additional Certificates/Courses
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
Date Attended
Name of Course/Seminar/Workshop
(MM/YY – MM/YY)
I certify that the information provided on the above application form is correct and truthful. I acknowledge that to provide
inaccurate or incorrect information on the application form can result in my application being withdrawn or if already
successful as interview, the job offer / contract being rescinded.
Signed Print Name Date
CCM Recruitment International, Gardiner House, 63 Lower Gardiner Street, Dublin 1, Ireland. Tel No.: +353-1-8366092
