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KHMH Job Application Form PDF Print E-mail

 

khmh logo smallAPPLICATION FORM FOR EMPLOYMENTkhmh logo small

ALL APPLICANTS MUST BE IN POSSESSION OF VALID A POLICE RECORD AND MUST BE REGISTERED BY THE BELIZE SOCIAL SECURITY BOARD.

 
Print, Complete and Mail in to:
 
Karl Heusner Memorial Hospital
Princess Margaret Drive
Belize City, Belize
Central America
P.O Box 1872

 

APPLICATION FRONT

 

Date of Application: _____/_____/_____

                                 Date/Month/Year

 

Position Applied for:

________________________________

 

(   ) Permanent       (     ) Temporary

 

 

 

 

 


PERSONAL INFORMATION

 

Surname: ________________   First Name: _________________ Middle Name: _________________

 

Address: _____________________________________________________ Sex: __________________

 

Telephone #: _____________ Social Security #: _______________ Date of Birth: _____/_____/_____

         Date/Month/Year

 

EDUCATIONAL ATTAINMENT

 

Type of School

Name of School

Area of Study

# of Years Attended

Completed

Primary School

 

 

 

Yes     No

High School

 

 

 

Yes     No

Sixth Form

 

 

 

Yes     No

University

 

 

 

Yes     No

Other

 

 

 

Yes     No

 

ACADEMIC AND PROFESSIONAL ACHEIVEMENTS

Indicate type or name                                                                                                            Date

 

 

 

 

 

 

 

SKILLS

Skills applicable to position applied for

 

CONTACT PERSON IF APPLICANT IS NOT AVAILABLE AT THE TIME OF INTERVIEW NOTIFICATION

Please print

Name

Address

Telephone #

Relationship to

 

 

 

 

 

 

 

 


 

 

 

 

 

 

Application Back

 

List ALL work experiences starting with the most recent job. If you have worked at four places of previous employer please indicate the name of personal references to be contacted.

(References should be submitted at the time of employment).

 

Previous Employers

Period of Employment

Position Held

Annual Salary

Reasons for Leaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been employed by any of the following? Tick where applicable

 

  • Belize City Hospital                                               (         ) Yes     (     ) No 
  • If yes, state name of reference    ­­­­­_________________________  Contact Number______________________                                                                            
  • Karl Heusner Memorial Hospital                 (     ) Yes     (         ) No 
  • If yes, state name department    __________________________                                                                                                              
  • Government of Belize                                      (     ) Yes     (         ) No                                                                                            If yes, state name of reference _________________________ Contact Number ________________

 

 

If the answer is yes to any of the above briefly state reason(s) for leaving on teh line below:

 __________________________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________________________________________________________

 

 

Signature of Applicant: _______________________________    Date: ____/____/_________

 

 

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