Job Application Form Photo

Please fill in each query clearly and completely. Type or write with black ball pen.

Position sought: Date of Application: / /

PERSONAL INFORMATION
Name:
Spouse name, if any: No. of children, if any:
Father’s name: Mother’s name:
Date of birth: Place of birth: Nationality:

Sex: О Male О Female Blood group:

Marital Status: О Single О Married О Separated/Divorced/widow

Contact Information, Mailing Address, E-mail address:

Work, if any Home, if any Personal, if any

Tele/Cell phone
Number:

Permanent contact information/address:

Have you previously applied for any job with MS: Yes/No
Name of position(s) When
If yes

Did you get a call for

Yes No
interview

Did you receive any job

Yes No
offer from Marie Stopes
If No, do you know reasons:

1
PREVIOUS EXPERIENCE

Please list beginning from most recent [you may use a separate sheet]

A)
Dates Employed Organisation Name Location Role/Title

Job responsibilities / tasks performed and reason for leaving:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

B)
Dates Employed Organisation Name Location Role/Title

Job responsibilities / tasks performed and reason for leaving:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

C)
Dates Employed Organisation Name Location Role/Title

Job responsibilities / tasks performed and reason for leaving:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

D)
Dates Employed Organisation Name Location Role/Title

Job responsibilities / tasks performed and reason for leaving:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

2
Summary of Educational Qualifications (Start with the highest qualification):
Academic Grade/ Year of
Name of Institution
Qualification Division Passing

Please list your areas of highest proficiency/expertise, experience, special skills or other items that
may contribute to your performing well in the position applied for (you may use a separate sheet):

3
Your present monthly salary and other benefits (optional):

Expected salary per month Taka _________________ Available Start Date_________________

How did you learn/hear about our vacancy?

О MS Internal circular О Circular О Newspaper advt.

О MS website О Jobsite О others

Do you know anyone personally or do you have any relative, working with MS?

Yes: О No: О
If yes, please give details

Name of two Referees [one must be current/last employer], MS will contact them only if you are
considered for appointment

a) Name: b) Name:
Contact address, E-mail, Telephone/ Mobile/ Fax: Contact address, E-mail, Telephone/ Mobile/ Fax:

DECLARATION
I do hereby confirm that any/all information and attachments given here are correct and I understand
that for any misleading/untrue information my application/appointment may be terminated.

Name:
Signature:

Date: