Aber Care Application Form
5 Tampines Central 6, #03-38, Singapore 529482 | www.Abercare.SG | Licence No.: 18C9070 | DID 6721 9231
Name *
First and last name
Nationality *
Gender *
Date of Birth* *
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Religion
Language Proficiency ( Spoken)
Language Proficiency ( Written)
Marital Status
Mobile number *
Email *
Registered with Nursing Board ? *
Work experience 1 *
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 2 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 3 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 4 ( if applicable )
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 5 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
Work experience 6 ( if applicable)
Please state name of employer , your appointment , Duration of stay, the total number of bed, Type of health care setting, Tertiary / secondary hospital, if you are not working during this period please state reason
1. Have you ever been dismissed or discharged from the service of any company? *
2. Have you been convicted, or been the subject of an inquiry or an investigation by any professional body, licensing or health authority in Singapore or elsewhere? *
3. Have you ever been convicted in a court of Law in any country? *
4. Have you suffered, or are suffering from any physical impairment or disease including mental illness, deafness, handicap, etc? *
5. Are you an undischarged Bankruptcy? *
If yes for Question 1 to 5, please specify
6. I consent to the collection, use and/or disclosure of your personal data by Aber Care Pte Ltd for the purposes of (a) assessing and evaluating your suitability for job placement with the client and/or other employers and/or potential employers, (b) verifying your identify and the accuracy of your personal details and other information provided, and (c) disclosing your personal data to the client and/or other employers and/or potential employers for them to assess and evaluate your suitability for employment and to verify your identity and the accuracy of your personal details and other information provided. *
Signature
Date
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