ROYAL INSTITUTE OF

MEDICINE & SURGERY

ADRESS : AL-KHALEEJ TOWER SHAHEED-E-MILLAT ROAD KARACHI
Phone: 021-34145152-54 Email: hr@rims.org.com
Website: www.rims.org.pk

Full Name:_______________________________ PMDC Registration: _________________

Position Title: ______________________________________________________________
Address:___________________________________________________________________
_________
Telephone: Business _____________________________ Home ____________________

PREVIOUS EMPLOYMENT (PLEASE LIST LAST THREE POSITION HELD, PUTTING THE MOST RECENT FIRST)
EMPLOYER POSITION HELD DATE FROM DATE TO

PREVIOUS EMPLOYMENT (PLEASE LIST LAST THREE POSITION HELD, PUTTING THE MOST RECENT FIRST)
EDUCATION BOARD INSTITUTE GRADE YEAR
The individual named above was working as a _________________in ___________________
Please verify the employment status for this individual:

Name: _________________________________ Position Title:_______________________

Organization:____________________________________________________________
Address:__________________________________________________________________
Telephone: ___________________ Nature of Association with Applicant:_____________

Have any disciplinary actions been taken against this applicant by an immediate supervisor or
by the Higher Authorities? _____Yes _____No

Comments:_______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

________________________________________________
Signature Date