EMPLOYMENT APPLICATION FORM

PLEASE COMPLETE IN FULL

PERSONAL DETAILS
Male Nurse
Position Applied for:

Title First Name Middle Name Last Name

X Mr. Mrs.
Ms. Miss SHERVIN FARINAS GUZMAN
Others
Date of Birth: 04 / 09 / 1986 Nationality: FILIPINO
Marital Status: X Single Married Widowed Divorce Others
Education MASTERS DEGREE Have you attested your X Yes
Qualification: Certificates? No
Current Address: FLAT 603 NBQ BLDG NO. 7 KING FAISAL ST UM AL Nearest International MANILA
QUWAIN, UAE Airport in your Home INTERNATIONAL
Permanent 203 MANGANDINGAY CABARROGUIS, QUIRINO Country: AIRPORT
Address: PHILIPPINES
Contact Numbers: 0565017700 / 0561769713 Email Address: shervin_guzman@yahoo.com
Languages Known: ENGLISH, ARABIC
Availability for WEEKDAYS FROM 8 AM TO 9:30 AM Skype ID: Shervin.guzman1
Interview: AND 1:30 PM TO 4 PM
How did you know Newspaper X Job Portal Referral
about the opening? Website Word of Mouth Others

IF APPLICABLE:
Type of Visa: X Company Spouse Parent Others
Current or Previous Employer under: X MOL Free Zone Government
Type of Contract: X Limited Unlimited
Visa Expiry Date: 07 / 09 / 2016 Contract Expiry Date: 07 / 09 / 2016
Passport No.: EB7914068 Passport Expiry Date: 17 / 04 / 2018

FOR HEALTHCARE PROFESSIONALS

Professional License: DHA HAAD X MOH Others
Date of Issue: 10/06/2014 Expiry Date: 10/06/2018
Medical Title in the REGISTERED NURSE
License:

EMPLOYMENT HISTORY
Current/Previous Employer
Name: Address: Contact No.: Email Address
DR. ASISH DENTAL CENTRE UM AL QUWAIN
SOON TO BE MEDICAL
CENTRE
Position Held: STAFF NURSE Notice Period:
JANUARY 25,2016
Current Ensure that proper staffing is available in the operating room and that it operates
Responsibilities: within budgetary guidelines as well as manage the ordering and stocking of
supplies. Assist of the Physician in performing procedures.
Start Date: SEPTEMBER 01,2014 Leaving Date
(if applicable):
Reason for TO SEEK OPPORTUINITIES IN A HOSPTAL SETTING INSTITUTION
Leaving:
Total No. of Years In UAE 1 YEAR 4 MONTHS Outside UAE 5 YEARS

Employment Application Form 1 26 July 2015

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Experience: Anesthesia technician Nurse June 2012 December 2013
Emergency-Resuscitation Department
with duties at the Ortho Trauma Ward
Zawia Teaching Hospital, AzZawiyah
Libya
350 Bed Capacity, 1:1 Nurse Patient
Ratio

Cases: Surgical cases such as Gun Shot

Wound, Road Traffic Accident, minor
Suturing of lacerated wounds,
Emergency Resuscitation

IV Therapy Lecturer June 2009 to June 2012

Quirino Provincial Hospital, Philippines
Association of Nursing Service
Administrators of the Philippines
1:60 student Ratio per lecture and
demonstration
Responsibilities: Prepares lectures as well
as demonstration and examination
questionnaires on the different aspects
of IV therapy including laws and proper
documentation.

Staff Nurse Operating Room and April 2008 June 2012

Delivery Room
With duties at the Surgical Ward
Quirino Provincial Hospital, Quirino
Philippines 100 bed capacity
Cases; Minor and major surgeries alike
ranging from General surgeries,
orthopedic/arthroscopic procedures,
EENT, Plastic as well as OB
surgeries.Performed actual delivery of
the baby and the placenta and
episorrhaphy up to the fourth degree.

COMPENSATION PACKAGE
Total Salary Basic Salary Accommodation Transportation Others

Benefits:

Salary Expectation:
6000 TO 7000 DIRHAMS
Benefits
Expectation:
REFERENCES (Must be your current or most recent employer (HR) & The Company at its discretion reserves the right to contact
the references provided):
Name Designation & Relationship Contact No. Email Address

Employment Application Form 2 26 July 2015

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Dr. Tayyab Ur Rehman GENERAL PRACTITIONER +971505354776
Muhammad Ilyas

Dr. Bader Al Bashir Ali HEAD DOCTOR OF +218925690129

Ashour EMERGENCY DEPARTMENT

Sonia A. Corpuz, RN, NURSE SUPERVISOR +639178749887

MAN

Employment Application Form 3 26 July 2015