Kingdom of Saudi Arabia ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬

Ministry of National Guard of Health Affairs ‫ﺍﻟﺸﺆﻭﻥ ﺍﻟﺼﺤﻴﺔ ﺑﻮﺯﺍﺭﺓ ﺍﻟﺤﺮﺱ ﺍﻟﻮﻁﻨﻲ‬

International Recruitment Application Form

Date of Application : DD / MM / YYYY

Position you are applying for :
Preferred location for employment
Riyadh Jeddah Madinah
Area of Speciality :
Al Ahsa Dammam PHCs
Photo
No Preference Availability :

Recruitment Source : Referred by : (Name & Badge No.)

Agency Internet

Local Referred

Rehire Other

Personal Data : (Please print clearly)

First Name : Permanent Address: c/o AFR RESOURCES AND

MANPOWER DEVELOPMENT
Second Name : CORPORATION

Family Name : Telephone No. : (c/o AFRRMDC) +63 9686612967

Gender : Religion : Mobile No. : (c/o AFRRMDC) +63 9686612967

Nationality : Current Address : c/o AFR RESOURCES AND

(No need to fill the current address MANPOWER DEVELOPMENT
Date of Birth : if it is the same as the permanent).
Age : CORPORATION
(DD-MM-YYYY)
Place of Birth : Telephone No./Mobile
(c/o AFRRMDC) +63 9273632804
(include Country) No. :
Height (in cm) : Weight (in kgs.) :

Marital Status: Email Address : (c/o AFRRMDC) jobs.afr@gmail.com

Name of spouse: Last name, first name

Is your Spouse living in the Kingdom? Yes No Company/Sponsor:

Iqama/Residency Permit No.: Visa Type: Work Dependent Visit
Emergency Contact
Name & Relationship Mobile No. :
Person :

Qualifications : (Please attach copies of all qualifications listed below)

Name of College/University Country Date Attended Qualification Gained
From To

Professional Licensing Body Country License/Registration No. Expiration Date

Non-Clinical Form Rev. 12/2023 Ref# APP 1423-02, Appendix D Page 1 of 2 APP 1427-18, Appendix C CPRA # 0601-1158
 Trainings Attended Date Attended Course Title

Employment History : (Start from current or most recent employment and attach a detailed CV/resume supporting this)

Hospital/Company/Employer Name & Address Dates Employed Last Position Held/Job Ward/Unit/ Department
(Include Country) Title (No. of beds in unit/ Nurse to
From To
(No. of Hospital beds, if applicable) patient ratio, if applicable)

Last Date of Employment :

Are you currently employed ? Yes No Date left (last employment) : / /

Work Related Reference who may be contacted :

Contact Information
Name Position/Job Title Consent to Contact
(Include country & area codes)
Home : Yes

Work : No (will not be contacted

Email : until consent is sought)

Authorization

I hereby authorize the Recruitment Services of Ministry of National Guard Health Affairs to request and obtain details held about me from
any organization, in order to exercise due diligence verifying the documents and details I have submitted to its office in support of my
educational qualifications and experience.
I understand that these organizations can include academic institutions, professional medical bodies, licensing and registration bodies and
my current and previous employers, including referees.
Furthermore, I declare that all the information that I have given above is correct to the best of my knowledge. I understand that I could
have my contract terminated (or my offer of employment cancelled); if it is found that I have deliberately given false or misleading
information or if my professional license is revoked during or after the application process.

Signature of Applicant : Date :

As an essential function and responsibility of a recruitment agency, I confirm that primary source verification of the above applicant's
license, qualification & experience will be implemented when offer released.

Recruitment Agency Information : (If applicable)

Name of Recruitment Agency :
Recruiter Name : Email :
Agency Signature : Date :

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION FORM. PLEASE NOTE THAT APPLICATIONS
EXPIRE AFTER ONE YEAR.

Non-Clinical Form Rev. 12/2023 Ref# APP 1423-02, Appendix D Page 2 of 2 APP 1427-18, Appendix C CPRA # 0601-1158