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PERSONAL PROFILE
Please list all information required (Delete the instructions (in green) after completing this section)

Full Name (as per I.C.):

NRIC Number:
Age:
Mobile Number:
E-mail Address:
Address:
Marital Status:
Height(cm)/Weight(kg):
Nationality:
Name of Emergency Contact:
Contact Number of Emergency Contact:
Last withdraw salary/Current salary(In RM):
Expected Salary (in SGD):
Notice Period:

EDUCATION/QUALIFICATIONS
Please list all relevant qualifications including high school qualification (SPM), professional qualification (diploma,
degree, Masters), post basic certification, etc. (Delete the instructions (in green) after completing this section)

Date Qualification Obtained

Qualifications Obtained
(Start & End Dates)
e.g University/College Name
Course Name

REGISTRATION WITH PROFESSIONAL BODIES

Please list your active registrations (e.g. Nursing Board, Medical Board, etc.), date obtained as well as the related
registration number(s). (Delete the instructions (in green) after completing this section)

Date Of Registration Registration Body Registration Obtained Registration No.

EMPLOYMENT HISTORY
Current Employment

Date Employed : - Current (DD/MM/YY – DD/MM/YY)

Position :
Unit :
Hospital :
No. of beds in Hospital :

Description of Unit: (indicate department or clinical speciality area, number of beds and nurse to patient ratio)
(Delete the instructions (in green) after completing this section)

Duties & Responsibilities: (indicate daily nursing duties performed and responsibilities including any supervisory
duties e.g. team leader, in charge duties, preceptor, acting etc.) (Delete the instructions (in green) after completing
this section)

Type of Cases & Patients Encountered: (list cases received and if patients are only adult, peds, mixed, combined)
(Delete the instructions (in green) after completing this section)
 

Type of Equipment Used:



Special Procedures Performed: (Indicate any special procedures performed or assisted Doctors with (E.g. lumbar
puncture, insertion & removal of CVP lines, Liver biopsy, Intubation, Extubation, Bone Marrow aspiration &
biopsy etc.) (Delete the instructions (in green) after completing this section)

Other Skills: (Indicate any other skills or experienced gained; e.g. quality process improvement, commissioning
experience, accreditation committee (audits/surveys) projects or research groups, etc.) (Delete the instructions (in
green) after completing this section)

Previous Employment (Please list down all previous employment)

Dates Employed : DD/MM/YY to DD/MM/YY

Unit :
Hospital :
No. of beds in Hospital :

Description of Ward/Unit: (indicate speciality area, number of beds and nurse to patient ratio) (Delete the
instructions (in green) after completing this section)
 Duties & Responsibilities: (indicate daily duties performed and responsibilities assigned including any
supervisory duties e.g. in charge duties, preceptor, acting etc.) (Delete the instructions (in green) after completing
this section)

 Not required if similar to current duties

COPY & PASTE IF NEEDED MORE ROWS FOR PREVIOUS EMPLOYMENT.

(ORDER FROM LATEST EMPLOYMENT AND FOLLOW ON) (Delete the instructions (in green)
after completing this section)

COURSES ATTENDED – last 2 years (Please specify only those which are relevant to the position applied)
Date Attended Name of Course/Seminar/Workshop

REFERENCES

Please provide contact details of 2 clinical referees. These MUST be people who have managed you in a clinical
setting. Please make sure you ask their permission first and provide the following details:
 Name :
 Title :
 Hospital Name & Ward :
 Phone Number :
 E-mail Address :

 Name :
 Title :
 Hospital Name & Ward :
 Phone Number :
 E-mail Address :