Application Form

APPLYING FOR POSITION OF:

MIDWIFE NURSE AUXILIARY BABYSITTER
NAME:

I.D.Nº.:

ADDRESS:

 

 

 

 

TELEPHONE:

Home

 

Mobile

 

Fax/Other

EMAIL:

D.O.B./ AGE:

NATIONALITY:

LANGUAGES SPOKEN:

LANGUAGES WRITTEN:

MARRIAGE STATUS:

CHILDREN:

Yes

No

HAVE CAR LICENCE?

Yes

No

CAR OWNER:

Yes

No

SMOKER:

Yes

No

DRINKER:

Yes

No

LENGTH OF TIME IN MALLORCA:

AVAILABLE

 

 

DAYS

NIGHTS

WEEKENDS

FIESTAS

ANY HOURS NOT AVAILABLE:

ANY WORK YOU WON'T DO:

BANK ACCOUNT DETAILS (IF RELEVANT)

RELEVANT QUALIFICATIONS AND YEAR COMPLETED:

1

2

3

4

COLLEGE/SCHOOL/UNIVESITY:

HOBBIES /INTERESTS:

SPECIAL EXPERIENCE IN ?:

 

Care Of Children

In Catheter Care

Care Of Babies

In Hoist Usage

Care Of Elderly

In Lifting Patients

Care Of Dementia

In Stroke Care

Care Of Handicapped

In Counselling

Care Of Psych. Ill

In Taking B.P.

Care Of Terminally Ill

In Blood Sugar Monitors

Care Of Cancer Experience

In S/C Injections

Care Of Infectious Diseases

In Incontinence Care

Care Of Post Op. Care

In Pressure Area Care

Local Clinic Work

In Rehabilitation

Private Home Care

In First Aid

NOTES/OTHER INFO:
     

WORK HISTORY:

 

 

POSTION

WHERE

FOR HOW LONG

REASON FOR LEAVING

1

2

3

4

5

     

REFERENCES:

 

 

1

 

 

NAME:

EMAIL:

TELEPHONE:

CONNECTION:

2

 

 

NAME:

EMAIL:

TELEPHONE:

CONNECTION:

3

 

 

NAME:

EMAIL:

TELEPHONE:

CONNECTION:

 

 

I HEREBY SIGN TO CONFIRM THAT ALL DETAILS AS GIVEN ARE CORRECT, TO THE BEST OF MY KNOWLEDGE, AND THAT I KNOW NO LEGAL REASON WHY I SHOULD NOT TAKE THE POSITION OFFERED TO ME.
 

NAME:

DATE:


Term's and Conditions

Angels, Caring for the People of Spain Since 1990