Name of Applicant: __________________ Position/s applied for: 1ST choice: ________________________ 2ND choice: ________________________

Application for Employment

Hospital Vision
To be the leading healthcare service provider in the Philippines and all the markets we serve.

Welcome to Asian Hospital & Medical Center. You are applying with a tertiary care hospital that espouses patient-centered care in a total healing environment. This means that we are committed to giving our patients the best quality of care and comfort possible to speed up their healing process and to create a positive experience. As a potential member of this organization, we will need to know your personal background, education, and professional experiences as well as your future plans. This will allow us to assess your qualifications and thereby determine your future in AHMC. Please take time to read this form. Ensure that you have answered completely and accurately all items asked for to facilitate the processing of your application. If the spaces provided are insufficient, you are allowed to attach additional sheets of paper. After you have completed this form, we will take time to evaluate your qualifications and credentials to ensure a proper fit in the position you are applying for. You will then receive a notice from us informing you of the next step in your application. We appreciate your time and effort in applying with us. Thank you for your interest in Asian Hospital and Medical Center.

Hospital Mission
To provide quality healthcare in a caring environment through committed and competent professionals, effective and efficient processes and technology, that exceeds the expectations of our patients, physicians and employees, while maintaining fiscal and social responsibility.

Guiding Principles
We create a caring environment that enhances our patients physical, emotional and spiritual health and well-being. We continually improve the quality of everything we do. We provide continuous development, support and recognition of our employees. We optimize our resources to deliver quality service, care and treatment. We work together with a passion towards a common purpose. We uphold ethical principles as a good corporate citizen.

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PERSONAL INFORMATION
LAST NAME CITY ADDRESS FIRST MIDDLE NICKNAME DATE OF APPLICATION

CONTACT NUMBERS
RESIDENCE: OFFICE:

PERMANENT ADDRESS

MOBILE: E-MAIL:

DATE OF BIRTH & PRESENT AGE SSS No. Sports/Hobbies: TIN

MARITAL STATUS PAG-IBIG No.

RELIGION Philhealth No. Languages

SEX

CITIZENSHIP PRC No. (if any)

Fair

Fluent

PROFESSIONAL PRACTICE
Use additional sheet if necessary
EMPLOYER Name: Add/Tel No.: Position & Department: Assigned: Job Summary DATE FROM TO LAST SALARY RECEIVED REASON FOR LEAVING/SEPARATION

Name Add/Tel No. Position & Department Assigned: Job Summary

Name: Add/Tel No.: Position & Department Assigned: Job Summary

Name Add/Tel No. Position & Department Assigned: Job Summary

COMMENDATIONS AND OTHER RECOGNITIONS RECEIVED FROM YOUR PRESENT/PREVIOUS EMPLOYERS

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PROFESIONAL/CAREER DEVELOPMENT
Use additional sheet if necessary
TRAINING PROGRAMS/SEMINARS/ OTHERS FROM DATE TO VENUE SPONSORED BY

LICENSES, PROFESSIONAL MEMBERSHIPS, PRIVELEGES AND OTHER RELATED INFORMATION

OTHER SKILLS (Computer proficiency, familiarity with office & treatment / medical machines)

EMPLOYMENT OPTIONS&OTHER INFORMATION

Are you available for: Full time employment Part time employment Temporary employment (casual/contractual/project) Yes No

What is your salary expectation? ___________________ Date of availability: _______________________________ Have you been involved in any legal case? If yes, describe your participation:

EDUCATIONAL BACKGROUND&PROFESSIONAL AFFILIATES

NAME OF SCHOOL/ ADDRESS POST GRAD STUDIES COLLEGE DEGREE HIGH SCHOOL ELEMENTARY VOCATIONAL/OTHER COURSES TAKEN GOVERNMENT EXAMS TAKEN / DATES / RATING DATE FROM TO COURSE / DEGREE HONORS/COMMENDATIONS RECEIVED

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FAMILY INFORMATION
Include spouse and children, parents and brothers and sisters
NAME RELATIONSHIP
BIRTHDATE

ADDRESS & CONTACT NUMBER

EMPLOYER OR SCHOOL

Do you have any relative/s employed with Asian Hospital? If yes, state the name and your relationship: ____________________________________________________________

Contact person in case of emergency: ____________________________________________ Relationship: _________________________________ Address: _____________________________________ _____________________________________________ Contact No/s. : _______________________________

MEDICAL HISTORY
A. State any major illness, major surgery or hospitalization in the last two years?

B. State all known allergies (ex. Dust, antibiotics, alcohol, aspirin, etc.)

Do you take maintenance medicine? (for asthma, hypertension, diabetes, etc.)

C. Do you have any physical limitations (limbs, sight, hearing?) Please specify: D. Do you wear glasses? Contact Lenses? Blood Type:

REFERENCES
Your references should not be related to you and must have known you personally for at least 2 years NAME ADDRESS CONTACT NUMBER/S & EMAIL ADDRESS

CERTIFICATION
I declare that the information given by me in this application form is correct and true to the best of my knowledge. I have not willfully suppressed any facts. I fully understand and accept that if any time after engagement, it is found that a false declaration has been made in this form, the Company has the absolute right to terminate my employment without assigning any reason.

_______________________________________ Printed Name and Signature of Applicant

___________________ Date

Note: Photocopies of all relevant documents including certificates and testimonials should be submitted together with this application. They are not returnable. Originals should not be enclosed but should be presented for inspection at the interview.

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