Scribd
Upload
210 views2 pages

Application Form For Saudi Moh - May 2019: Educational Qualifications

This document is an application form for Saudi MOH containing sections for registration details, educational qualifications, professional registration, Saudi licensing exam details, work experience, gaps in employment if any, and personal profile. The applicant provides contact information and declares that the information given in the application is true and correct and expresses willingness to attend Saudi MOH interview through ODEPC.

Uploaded by

Saranya Prinil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
210 views2 pages

Application Form For Saudi Moh - May 2019: Educational Qualifications

This document is an application form for Saudi MOH containing sections for registration details, educational qualifications, professional registration, Saudi licensing exam details, work experience, gaps in employment if any, and personal profile. The applicant provides contact information and declares that the information given in the application is true and correct and expresses willingness to attend Saudi MOH interview through ODEPC.

Uploaded by

Saranya Prinil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

APPLICATION FORM FOR SAUDI MOH – May 2019

ODEPC Registration Interview Venue Preference


Number (Kochi dated 20,21,22,23,24,)
1.
2.
3.
4.

NAME:

ADDRESS:
Insert Photo Here
CONTACT
NUMBER:(Mention at
least 2 contact numbers)

EMAIL:

Educational Qualifications(You may add/delete rows as required)

TITLE OF NAME & PLACE OF


SL NO YEAR OF PASSING
QUALIFICATION UNIVERSITY/BOARD

1 M.Sc Nursing

2 B.Sc. Nursing

3 PLUS TWO

4 SSLC

Professional Registration

REGISTRATION DATE OF
SLNO NAME & STATE OF NURSING COUNCIL
NUMBER REGISTRATION

01

02

Saudi Prometric(Saudi Licensing Examination for Health Specialties)

ELIGIBILITY ID SCHS ID DATE OF ISSUE GRADE


Employment/Work Experience(Latest First)(You may add/delete rows as required)
Total Experience Years Months
DURATION OF
SL EMPLOYMENT NAME & PLACE OF BED
DEPARTMENT
NO FROM TO HOSPITAL CAPACITY
(DD/MM/YYYY) (DD/MM/YYYY)

Gaps in Employment, if any(You may add/delete rows as required)

SL.NO. FROM TO REASON


(DD/MM/YYYY) (DD/MM/YYYY)

1.
2.

Personal Profile

Name
Date of birth
Gender
Name of Father
Marital status (Married/Single)
Name of Husband
Nationality
Religion
Adhar
Passport Details
Passport No: Date of Issue:
Place of Issue: Date of Expiry:

Declaration
I hereby declare that the information given in thisCV is true and correct. I also inform my willingness to attend
the Saudi MOH interview to be conducted in the first quarter of 2018 through ODEPC.

DATE: NAME:

You might also like