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Reference;
EMPLOYMENT APPLICATION
Pleace give details of three refrees one of whom should be your supervisor at your present or
most recent place of work. Relatives are not acceptable TE
A C HI N G H
O
E
SP
Y
O ANOK
ITA
Name: ......................................................... Relationship ....................................................... KOMFO ANOKYE TEACHING HOSPITAL
L, KUMA
KA TH
MF
KO
Postal Address........................................... Phone Number...................................................
S
I
A E
CE C
NTR EN
E OF EXCELL
E-mail: ........................................................
Name: ......................................................... Relationship .......................................................
Postal Address........................................... Phone Number...................................................
E-mail: ........................................................
Passport-sized Picture
Name: ......................................................... Relationship .......................................................
Post Applied For................................................................................................................................
Postal Address........................................... Phone Number....................................................
E-mail: ........................................................
PART 1
PERSONAL INFORMATION
Declaration Name ..................................................................................................................................................................
Surname First Name Middle name
Icertify that to the best of my knowladge and belief, the information provided on this
application form, together with any document attached is true and accurate. I understand that Title Prof Dr Mr. Mrs. Miss Ms
giving false information or failing to disclose details will make any offer of employment
Other Specify
invalid or will lead to the termination of employment
Address .............................................................................................................................................................
Signature: ................................................... Date...................................................... .............................................................................................................................................................................
Phone No(s) ................................................................ E-mail.....................................................................
Date of Birth: .............................................................. Nationality ..............................................................
Have you ever been convicted of a criminal offence? ...............................................................
If ‘Yes’ give details .........................................................................................................................................
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2 Personal Statement/Competency Record
................................................................................................................................................................ This section gives you the oppotunity to tell us about your skills and abilities that makes you a
Have you ever been dismissed or removed or asked to resign from a job? .......................... suitable candidate for the post. Give examples of expriences encountered in your professional
life.
If ‘Yes’ give details ............................................................................................................................
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PART II
EDUCATIONAL AND TRAINING
Education Please state qualifications relevant to this post. Attach copies of Certificate to form
School From-To Qualification Obtained Year
Relevant Training
Training Course Date Attended
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Professional License or Certificate
License/Certificate Date
Research and Publication
Please give details of your reseach and publications (you may continue on additional sheet)
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PART III
EMPLOYMENT HISTORY (Please start with the most recent)
From To Address & Name Position held, describe main duties and
Month/Year Month/Year of Employer reasons for leaving
Position:
Main Duty:
Reason for leaving:
Position:
Main Duty:
Reason for leaving:
Position:
Main Duty:
Reason for leaving:
Position:
Main Duty:
Reason for leaving:
Position:
Main Duty:
Reason for leaving:
Position:
Main Duty:
Reason for leaving:
