PER-034

YAN CHAI HOSPITAL SOCIAL SERVICES DEPARTMENT

仁濟醫院社會服務部
JOB APPLICATION FORM
職位申請表

Position Applied for CONFIDENTIAL

申請職 位 機密

I. Personal Particulars 個人資料

Name (English) (Chinese) Sex
姓名 (英 文) (中 文) 性別
H.K. Identity Card No. Date of Birth
香港身份證號碼 出生日期
Address
住址
Telephone no. (Home)　 (Mobile)　
聯絡電話 (住宅) (流動電話)
E-mail Address
電郵地址

II. Academic Qualifications (in reverse chronological order) 學歷（按最近期填寫）：

Dates Attended/Attending
Schools, Colleges, Universities, Institutions etc.
就讀期間 Qualifications Obtained / to be Obtained
Attended / Attending
(Month 月/Year 年) 已獲取／將獲取學歷
曾經／現在就讀的學校、學院、大學、機構名稱
From 由 To 至

III. Professional Qualifications/Memberships (in reverse chronological order) 專業資格（按最近期填寫）：

Date of Award
Name of Institution Qualification / Membership obtained
頒發日期
機構名稱 所獲專業資格
(Month 月/Year 年)

IV. Employment Record (in reverse chronological order) 就業詳情（按最近期填寫）：

Period 期間 Reason for
Name of Company Position held Last Salary
(Month 月/Year 年) leaving
機構名稱 職位 最後薪金
From 由 To 至 離職原因

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V. Criminal Offence 刑事紀錄
A criminal conviction is not necessarily a barrier to employment 申請人之刑事紀錄，不
一定導致不獲本院聘用
Have you ever been convicted of a criminal offence (including sexual offence) in a court of law?
閣下有沒有曾因刑事案件（包括性罪行）被法庭定罪？

□ No 沒有 □ Yes 有　　Please state 請列明：

Are you involved in an ongoing criminal proceedings or investigations?
閣下有沒有現正涉及刑事訴訟或調查？

□ No 沒有 □ Yes 有　　Please state 請列明：

Have you ever been conducted the Sexual Conviction Record Check (SCRC) under implementation of the Sexual Conviction
Record Check Scheme in Hong Kong?
閣下有沒有曾就「性罪行定罪紀錄查核機制」的推行而向香港警務處進行查核申請?
□ No 沒有 □ Yes 有　　 Unique checking code: *valid until: / invalid

查詢密碼： *仍有效，有效期至： / 已無效

*Please Delete as appropriate 請刪去不適用者

VI. Connections 與本院之聯繫

Do you know anyone working in Yan Chai Hospital Social Services Department?
閣下有沒有認識的人士現於仁濟醫院社會服務部工作？
□ No 沒有 □ Yes 有　 Name 姓名 Position 職位 Relationship 關係
______________________ __________________ _________________
______________________ __________________ _________________

Have you worked as a relief worker in Yan Chai Hospital Social Services Department’s unit(s)?
閣下是否曾於仁濟醫院社會服務單位任職替工？
□ No 否 □ Yes 是　 Unit 單位名稱： _______________________________________________
Channel 途徑： □ Self-applied 自行申請
□ Intermediary Company 中介公司
Name of Company 中介公司名稱： _________________
** Our agency reserves the right to claim against you all fees paid to the relevant companies and all losses incurred if arising from your
service provision to our agency.
**如閣下因透過中介公司到本院工作，而令本院需要向相關公司支付任何費用或導致本院有任何損失，本院有權
向閣下追討所有相關費用。

VII. Others 其他
Expected Salary $ Notice Period Date of Availability
要求待遇 $ 離職通知期 可到職日期
Do you agree our agency to transfer your personal data contained in this job application form to other service units under our agency
for considering your suitability in other job vacancies that our agency may have?
閣下是否同意本院將此職位申請表內的個人資料轉交至本院其他服務單位，以考慮閣下是否適合本院其他的職
位空缺？
□ Yes 是 □ No 否
How do you know about this job vacancy? 閣下如何得知此職位空缺？
□ Newspaper/Magazine 報紙／雜誌 □ Website 網站
(Please specify　請註明： ) ( Please specify　 請註明： )
□ Friend/Relatives　朋友／親屬介紹 　　 □ Job Fair/Recruitment Talk　招聘會／講座　　
□ Labour Department　勞工處　　 □ Notice in Service Unit　服務單位的招聘廣告

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□ Others　其他 (Please specify　請註明： )
VIII. Referees 諮詢人
(Please provide information and contact of two persons who can comment on your capabilities and conduct. They must not be your next of
kin and one of whom should be your most recent employer.)
(請提供能就閣下的工作能力及品格給予意見的兩位非近親人士的資料及聯絡方法，其中一位須為閣下最近的僱主。)
Name Occupation Relationship Name and Address of Organization
姓名 職業 關係 機構名稱及地址

Telephone No
1
電話
Email Address
電郵地址

Telephone No
2
電話
Email Address
電郵地址

IX. Declaration 聲明
1. I authorize Yan Chai Hospital Social Services Department to disclose my information (including personal data) that I have provided to
the organization(s) and relevant person(s) as stated in my job application, and I hereby give my consent to Yan Chai Hospital Social
Services Department or its delegate to obtain and the relevant organization(s) and person(s) to release information regarding my
employment and conduct for the consideration of my job application.
本人授 權仁 濟醫 院 社 會 服務 部 或其 代表 就 本人 的職 位申 請 將本人 提供 的資 料 （包 括個 人資 料 ） 披露予
職位申 請表 上所列 的 機構及 有關 人士 ，並 可向 有關 機構 及人 士 查詢本 人的 工作 紀錄 及品格 ，而 本人 亦
授權 有關 機構 或人 士 向 仁濟醫 院社 會服 務 部 披 露有 關 資 料 。

2. I understand and agree that Yan Chai Hospital Social Services Department will request me to undergo Sexual Conviction Record
Check (SCRC) in order to assess my suitability of my job application.
本人明白及同意仁濟醫院社會服務部可要求本人進行性罪行定罪紀錄查核，以 評定本人是否適合擔任
有關工 作。

3. I hereby declare that all the information given in this application form and any attachment of documentary proof(s) (including
academic, professional qualification and employment record) are true and complete. I understand that any willful misrepresentation or
withholding of material information will render me liable to disqualification for employment or to summary dismissal, if already
appointed.
本人 確 認 在本表 格內 所提供 的 所有 資料 及任 何 附 帶 的証 明 文 件 （包 括 學 歷 、專 業 資 格 及工 作 証 明 ）為
正確及 完整 。本 人 明 白 倘若 故 意 虛 報資 料 或 隱 瞞重 要 事 實 ，可 令 本 人 喪失 錄 用 資 格， 即 使 已 錄用 ， 亦
可遭解 僱。

Signature Date
申請人簽署 日期
Name 姓名
HKID No. 香港身份證號碼

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General Notes
一般事項

1. Please read the Personal Information Collection Statement before completing the job application form.
申請人在填寫職位申請表前，請詳細閱讀收集個人資料聲明。

2. Applicants will be required to produce documentary evidence pertaining to the qualifications and working experience where
appropriate. The entry salary offered will depend on the qualifications and relevant working experience of the applicant in accordance
with the established human resources policies.
申請人需出示學歷及工作証明文件以供核對，入職薪酬將按申請人的資歷、相關工作經驗及既定人力資源政策
而定。

3. Yan Chai Hospital Social Services Department is an equal opportunity employer. We offer appointments to candidates with
competitive packages commensurate with qualifications, experience and capability.
仁濟醫院社會服務部為平等機會僱主，一切招聘均以申請人之履歷、經驗及勝任能力作考慮。

Personal Information Collection Statement

收集個人資料聲明

1. The information provided will be used for employment related purposes. The personal data collected in this application form will be
used to assess your suitability to assume the job duties of the position for which you have applied and to determine preliminary
remuneration and benefits package to be discussed with you subject to selection for the position.
申請人所提供的資料將用作僱傭有關事宜。本院會將申請表所收集的個人資料，使用於評估申請人是否適合擔
任所申請的職位，以及在申請人獲挑選出任該職位時，用作與申請人商討初步的薪酬及福利。

2. It is our policy to retain the personal data of unsuccessful applicants for future recruitment purposes for a period of 3 months.
Information on all unsuccessful candidates will be destroyed 3 months after the application deadline. When there are vacancies in
other service units under our agency during the retention period, we may upon your consent transfer your application for their
consideration.
本院的政策是為日後的招聘活動保留求職者的個人資料三個月。未獲取錄的申請人資料，將於截止申請日期後
三個月銷毀。如本院的其他服務單位在此保留期間出現職位空缺時，本院獲你同意 下或會將你的申請轉交有關
單位考慮。

3. Under the Personal Data (Privacy) Ordinance, you have the right to request access to, and to request correction of, your personal data
in relation to your application. If you wish to exercise these rights, please contact our Human Resources Section.
根據《個人資料(私隱)條例》，申請人有權要求查閱及更正申請表上所填報的個人資料。如申請人欲行使這項權
利，請聯絡本院人力資源組辦理。

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