2 Bukit Batok Street 11

Singapore 659674

Website: www.slh.org.sg

Tel: 6563 2281 Fax: 6561 8205

Job Application Form

Instructions:

1)  This is a standard form. Please fill in all fields. Those marked (*) are optional. However for administrative purposes, you will be required to fill in these fields after you have been selected for the job.

2)  Please attach photocopies of your educational transcripts and certificates, National Service certificate of service (if any) and other relevant supporting documents.

Position Applied for:
Personal Particulars
*Salutation Dr Mr Mrs Miss Mdm Ms
Name as in Identity card/ Passport (in BLOCK LETTERS)
(underline surname)
/ Alias
(if applicable) / Chinese Characters
(if applicable)
Address
/ Postal Code
Home Tel No. / Handphone No. / Email
NRIC /FIN /Passport No. / Nationality / Citizenship
Singapore Citizen / SPR / Others : / Are you presently on any pass
( For Non-Singapore Citizens/Residents only)
Employment Pass S Pass
Work Permit Others:
*Date of Birth / *Gender / *Marital Status / *No. of Children (if applicable)
*Religion
/ *Church Attending (if applicable)
Language / Dialect proficiency
Language / Dialect / Spoken / Written
Fluent / Fair / Poor / Fluent / Fair / Poor
Special hobbies, skills and abilities (e.g. musical instruments, crafts, etc.)
Educational Background
1. Primary, Secondary and College levels or equivalent in chronological order (Please attach certificates & results)
School / Institution Name / Country / Date (from) / Date (to) / Highest standard attained
2. Professional Certificate, diploma and degree levels in chronological order (Please attach certificates & results)
Institution/ University Name / Country / Date (from) / Date (to) / Highest standard attained
3. Course currently attending
Institution / University Name / Country / Date (from) / Date (to) / Course Name
4. Academic distinctions/ awards and publications
Work Experience
Name of Current Employer / Current Position / Date Joined
Nature of work
Previous Working Experience in chronological order (please attach resume with details if necessary)
Name of Previous Employer / Position Held / Period of service (from / to)
Referees (Do not include your friends, family members and relatives)
Please name two persons to whom reference about your past employment can be made.
Particulars / 1st Referee / 2nd Referee
Name of Referee
Occupation
Name of Company
Contact Address
Email
Contact Number(s)
Relationship
Years known
General (If the answer is “Yes” please give details)
1.  Do you have any criminal record?
/ Yes No
2.  Are you an undischarged bankrupt and/or have any bankruptcy proceedings started on you?
/ Yes No
3.  Have you ever been terminated, dismissed, discharged or suspended from employment? / Yes No
4.  Have you any medical history for any medical condition, illness, disease, mental illness or physical impairment? / Yes No
5.  Have you any history of surgical procedures done or undergone any medical treatment? / Yes No
6.  Are you presently still on any treatment/medication? / Yes No
7.  Have you completed treatment for any surgical procedures / medical treatment? / Yes No
8.  Have you any history of allergy? / Yes No
9.  Do you have any relatives/ friends currently employed by St Luke’s Hospital or do you know anyone currently employed by St Luke’s Hospital? / Yes No

I hereby declare that the information and particulars provided above are true and correct in all aspects and I have not willfully suppressed any material fact. I understand that misrepresentation or omission of any material fact in this form will be grounds for withdrawal of an employment offer or liable for immediate termination of my service.

In relation to this application, I voluntarily give St Luke’s Hospital the right to make reference checks of my past and present employment and activities, agree to co-operate in such investigations, and release from all liability or responsibility, all persons, companies or organisations supplying such information.

Signature / Date

Note : If there is insufficient space on this form, please attach additional sheets.

Last updated 1 Oct 2013 Page 1 of 2