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Transforming Care.

Bringing Health To Every Home.

EMPLOYMENT APPLICATION
PRIVATE & CONFIDENTIAL
Note:
The words NIL or NA (Not Applicable) should be entered where applicable.

POST APPLIED:

PART 1: PERSONAL PARTICULARS

Full Name (as in NRIC/Passport) (Please underline surname)

Citizenship (please tick accordingly)


 Singapore Citizen  Singapore Permanent Resident  Foreigner

Address in Singapore

Postal Code ( )

Overseas Address (if applicable)

Contact Numbers Email


Mobile:

Home/Office:

PART 2: EDUCATION AND TRAINING


Name of School / Institution / Country From To Course / Major Highest Qualification
dd/mm/yy dd/mm/yy (Certificate / Diploma / Degree)

Page 1 of 4
Human Resource Division
378 Alexandra Road, Singapore 159964
COURSES CURRENTLY ATTENDING
Name of School / Institution / Country From To Course / Major Highest Qualification Company
dd/mm/yy dd/mm/yy (Certificate / Diploma / Degree) Sponsored

 Yes  No

 Yes  No

SCHOLARSHIP / BURSARY (if any)


Name of School / Institution / Country From To Course / Major Name of Scholarship
dd/mm/yy dd/mm/yy & Length of Bond Period

Name of Award Date Contents of the Award


dd/mm/yy

PART 3: GENERAL INFORMATION


SKILLS

What PC software applications are you familiar with?

LINGUISTIC PROFICIENCY
Language / Dialect Spoken (Tick one) Written (Tick one)

Fluent Fair Poor Fluent Fair Poor

     

     

     

     

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Human Resource Division
378 Alexandra Road, Singapore 159964
PART 4: EMPLOYMENT HISTORY
(Please complete in chronological order. Use separate sheet if space is insufficient.)
Name of CURRENT / PREVIOUS Major Duties & Responsibilities From To
employer dd/mm/yy dd/mm/yy

Country:
Designation / Department Last Drawn Basic Salary (S$)

Reason(s) for leaving


AWS:

Bonus:

Other Allowances:

Annual Leave:

Name of CURRENT / PREVIOUS Major Duties & Responsibilities From To


employer dd/mm/yy dd/mm/yy

Country:
Designation / Department Last Drawn Basic Salary (S$)

Reason(s) for leaving


AWS:

Bonus:

Other Allowances:

Annual Leave:

Name of CURRENT / PREVIOUS Major Duties & Responsibilities From To


employer dd/mm/yy dd/mm/yy

Country:
Designation / Department Last Drawn Basic Salary (S$)

Reason(s) for leaving


AWS:

Bonus:

Other Allowances:

Annual Leave:

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Human Resource Division
378 Alexandra Road, Singapore 159964
PART 5: SALARY EXPECTATION / NOTICE PERIOD
Minimum Expected Salary per month Notice Period Required Earliest Start Date

S$

PART 6: DECLARATION
Questions Please Tick If yes, please provide details

Yes No

1. Do you have any obligation to your present company in


terms of bonds, study loans etc?

2. Do you suffer from any physical impairment or disease


including mental illness, deafness, handicap,
hypertension, diabetes, heart disease?

3. Have you ever been declared a bankrupt?

4. Have you ever been dismissed or terminated from the


service of any company?

5. Have you ever been convicted in a Court of Law in any


country or any ongoing legal proceedings?

6. Have you ever been detained by the police, military


police, CID, CPIB or any other government law
enforcement Institution?

7. Have you ever been to interviews for employment in


JurongHealth?

8. Do you have any relatives and / or friends working in


JurongHealth?

9. Have you ever been immunised against Hepatitis B?


(For medical staff only please provide documentary
evidence if immunised)

10. How did you come to know about this job vacancy at JurongHealth?
 Advertisement  Friends / Relatives  Employment Agency
 Online Job Portal  JurongHealth Website  Others:

Other information which you think may be useful for this application:

I understand that any false statement made by me on this application or any supplement thereto will be sufficient for disqualification
from any offer of employment or dismissal if appointed. The willful suppression of any material fact will be similarly penalised.

I hereby authorise JurongHealth to make references to all my past employers. However, reference to my current employer may
only be made with my prior permission provided that I am still in their employment.

_________________________________ ________________
Signature of Applicant Date

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Human Resource Division
378 Alexandra Road, Singapore 159964

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