CV - Data Collection Form

Name: ____________________________________ DOB _____________________

Nationality_________________________________ Position: __________________

Total Years of Experience: _______________________________________________________________

Educational Qualifications: ______________________________________________________________

License:

□ Home Country; specify: _______________ Issuance date: _______________ Expiry date: ___________

□ GCC License; specify: _________________ Issuance date: ________________Expiry date: __________

□ GCC License; specify: _________________ Issuance date: ________________Expiry date: __________

□ Other; specify: _____________________ Issuance date: ________________Expiry date: __________

Languages: □ English Level____________________________
□Arabic Level ____________________________

□Other; Specify _____________________ Level ____________________________

□Other; Specify _____________________ Level ____________________________

Professional experience: From Newest to oldest

Experience 1:
Facility Name: _________________________________ Country: _________________________
Start date: _________________ End Date: __________________ Total period: _____________________
Ward/unit: ___________________________________________________________________________
Hospital capacity: ___________________________ Accreditation: ___________________________
Area: □Medical surgical, specify duration: ___________ □Oncology, Specify duration: ________
□Hemodialysis, specify duration: _____________ □Obstetric, Specify duration: ________
□Neonate, specify duration: _________________ □ICU, specify duration: _____________
□Pediatric; specify duration ________________ □Psychiatric; Specify duration________
□Others; Specify________________________________________________________________

Description of duties:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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Experience 2:
Facility Name: _________________________________ Country: _________________________
Start date: _________________ End Date: __________________ Total period: _____________________
Ward: _______________________________________________________________________________
Hospital capacity: ___________________________ Accreditation: ___________________________
Area: □Medical surgical, specify duration: ___________ □Oncology, Specify duration: ________
□Hemodialysis, specify duration: _____________ □Obstetric, Specify duration: ________
□Neonate, specify duration: _________________ □ICU, specify duration: _____________
□Pediatric; specify duration ________________ □Psychiatric; Specify duration________
□Others; Specify________________________________________________________________

Description of duties:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Experience 3:
Facility Name: _________________________________ Country: _________________________
Start date: _________________ End Date: __________________ Total period: _____________________
Ward: _______________________________________________________________________________
Hospital capacity: ___________________________ Accreditation: ___________________________
Area: □Medical surgical, specify duration: ___________ □Oncology, Specify duration: ________
□Hemodialysis, specify duration: _____________ □Obstetric, Specify duration: ________
□Neonate, specify duration: _________________ □ICU, specify duration:_____________
□Pediatric; specify duration ________________ □Psychiatric; Specify duration________
□Others; Specify________________________________________________________________

Description of duties:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Experience 4:
Facility Name: _________________________________ Country: _________________________
Start date: _________________ End Date: __________________ Total period: _____________________
Ward: _______________________________________________________________________________
Hospital capacity: ___________________________ Accreditation: ___________________________

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Area: □Medical surgical, specify duration: ___________ □Oncology, Specify duration: ________
□Hemodialysis, specify duration: _____________ □Obstetric, Specify duration: ________
□Neonate, specify duration: _________________ □ICU, specify duration: _____________
□Pediatric; specify duration ________________ □Psychiatric; Specify duration________
□Others; Specify________________________________________________________________

Description of duties:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Training and Certificate: From Newest to oldest

□ILS, Date: ____________________________________
□PLS, Date: ___________________________________
□Others:______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Skills:
□Computer; Specify ____________________________________________________________________
□Medical Record, Specify________________________________________________________________
□Others:______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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 NURSE COMPETENCY declaration

Experience/ Exposure Too Competent Nursing Skills 1 2 3 4 Competent Nursing Skills 1 2 3 4

Tick all that apply.
Ob-Gyne Ward/Unit/Clinic Blood Pressure Monitoring Tube feeding management. PEG. NJT. NGT

Mother & Baby Temperature reading Gravity Bolus feeding

Neonatal care Nurse Pulse Rate Monitoring Feeding Pump

Lactation/ breast feeding Spo2 Monitoring Stoma management

Pediatric/child care Nurse Neurological Assessment Peg change (Micky, Long Tube)

Learning disabilities Nurse. Glasgow coma scale Infection Control/ Aseptic Non touch technique

Mental health Nurse Adult Full body Assessment Wound care Management.

Psychiatric/counselling Pediatric Full Body Assessment Wound grading and staging

Adult care Nurse Safe Moving & Handling of patients Management of Skin Integrity

Elderly care Nurse Medication Management Holistic Care/Psychosocial Nurse Therapy

End of life/Palliative care. Pain Management Physical Therapy

Medical ward/unit Nurse Blood Glucose management Occupational Therapy

Surgical ward/unit Nurse IV cannula insertion Respiratory Therapy

Outpatient’s clinic Nurse. Intravenous Therapy Emergency Care

Surgical/Theatre Scrub Nurse. Point of Care Testing (POCT) High Dependency care

Community/ district Nursing. Blood Collection Intensive care

Private home care Nurse. Injections SC Basic Life Support

Company Nurse. Injections IM Advanced life Support

Construction Site Nurse. Injections IV Chronic long term care

Nursery Nurse/ School Nurse. Suction/oral/nasal/trach. Generic Equipment IV pump

Acute Care Nurse Tracheostomy Management Profile bed

Senior Staff Nurse Tracheostomy change Hoist

Team Leader Ventilator Management/Cpap/Bpap Effective nurse documentation Endorsement.

Charge Nurse/Head nurse Oxygen therapy Culture & Sensitivity

Nurse Educator Nebulisation therapy Health Promotion health education

Preceptor/Mentor Auscultation lung fields/Abdomen Arabic Speaking

Clinical coordinator Nutritional Management Arabic writing

Specialist Nurse. Oral feeding English writing , English speaking

1= Proficient 2=Experienced 3=Knowledge 4= Nil experience.

Candidates Name ____________________________________________ Signature __________________________________ Date ____/____/______

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