CONFIDENTIAL
OBAFEMI AWOLOWO UNIVERSITY
TEACHING
HOSPITAL COMPLEX, PMB 5535 ILE-IFE,
EMPLOYMENT APPLICATION
NIGERIA
FORM
PLEASE READ AND COMPLETE THE FORM
CAREFULLY
1. POST APPLIED
FOR…………………………………………………………………………………………………………...........
2. SPECIALTY/DISCIPLINE……………………………...
3. FULL NAME…..…………………………………………………………………….
……………………………………………………………………………..
…………………………….............................
(Block (Maiden
letters)
4. PHONE NO…………………………………………………………………………. name)
………………………………………………….
5. SEX………………………………………..6. TITLE…………………...………….
……………………………………………........
7. DATE OF BIRTH (DD/MM/YR)……………….……………………………………………………..
………………......................
8. NATIONALITY…………………..…………………… 9. HOME TOWN ……….
…………………………………………...........
10. STATE OF ORIGIN…………………………… 11. LOCAL GOVT. AREA…...………………………….
…………………….
12. SENATORIAL DISTRICT……………………………………………13. MARITAL
STATUS………………………………….
14. NUMBER OF CHILDREN (WITH DATES OF BIRTH)………………………………………………..…...
…………………….
…………………………………………………………...
……………………………………………………………………………..
15. CONTACT/POSTAL ADDRESS (CURRENT)…...……………………………….
………………………………………………
..
…………………………………………………………………………………………………………………………………
16. E-MAIL ADDRESS ………………………………………………………………………...
……...
………………………………………..
.
17. PERMANENT HOME TOWN
…………………………………………………………………………………………………………………………………
ADDRESS…………………………………………………………………………………………
25.
….……
18.EDUCATION/QUALIFICATIO
(Please state(IF
DISABILITY names/schools/colleges attended and qualifications obtained with dates)
ANY)………………………………………19.NEXT-OF-
……………………………………………………………………………………………………………………………………
N
..
KIN…………………………………………………..
.……..
…………………………………………………………………………………………………………………………………
20.……...
ADDRESS OF NEXT OF KIN…..
26. PROFESSIONAL QUALIFICATIONS (with dates and issuing authority)
…………………………………………………………………………………………………..
………………………………………………...
21.…….RELATIONSHIP WITH NEXT OF KIN ……………………………22. PHONE NO (NEXT OF KIN..
…………………..…...
………………………………………………………………………………………………………………………………….
23..PHONE NO…………………...
……………………………………………………………………………………………………....
..
24.…………………………………………………………………………………………………………………………………
MEMBERSHIP OF PROFESSIONAL ORGANIZATION(S)/BODY…………..
……...
………………………………………………..
27. IF SPONSORED FOR A COURSE, HAVE YOU BEEN RELEASED FROM BOND BY THE
…………………………………………………………………………………...
SPONSORING BODY?
………………………………………………………
YE/
NO………………………………………………………………………………………………………………………………
….SALARY GRADE LEVEL……………………………………i.e (N)..
29.
………………………………………………………..P/A
28. PRESENT APPOINTMENT:
POST………………………………………………………………………………………………..
30. DATE APPOINTED TO PRESENT POST…………………………………………………………………..
……………………
31. NAME & ADDRESS OF PRESENT EMPLOYER……………………...……………………………….
………………..……...
32. REASONS(S) FOR WISHING TO LEAVE PRESENT
EMPLOYMENT………………………………………………………
33. PREVIOUS
APPOINTMENTS……………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………
……....
34. HAVE YOU BEEN CONVICTED OF ANY CRIMINAL OFFENCES OR PREVIOUSLY DISMISSED
FROM THE
SERVICE? IF YES, PLEASE STATE
DETAILS………………………………………………………………………………...
35. RESEARCH/PROJECTS (STATING TOPIC(S), YEAR, AND STATUS OF PUBLICATION)
………………………………
a. …..
NAME AND
…………………………………………………………………………………………………………………………………
POSITION………………………………………………………………………………………………………………..
…...
ADDRESS….
36. DISTINCTION AND AWARD (IF ANY)…..
……………………………………………………………………………………………………………………………
………………………………………………………………………………………..
PHONE NO………………..
37. ON-GOING PUBLICATIONS WITH DATES……...
…………………………………………………………………………………………………………….
……………………………………………………………………………....
b. NAME AND POSITION……..
38. EXTRA-CURRICULAR ACTIVITIES……..
…………………………………………………………………………………………………………
………………………………………………………………………………………..
ADDRESS…..
39. REFEREES
…………………………………………………………………………………………………………………………...
PHONE NO……………………..
……………………………………………………………………………………………………….
c. NAME AND POSITION……..
………………………………………………………………………………………………………….
ADDRESS…..
…………………………………………………………………………………………………………………………...
THE FOLLOWING MUST BE ATTACHED TO THE COMPLETED EMPLOYMENT
FORM BEFORE
PHONE NO……………………..
SUBMISSION
(i) PHOTOCOPY OF ALL RELEVANT EDUCATIONAL AND BIO-DATA DOCUMENT/
……………………………………………………………………………………………………….
CERTIFICATE
(ii) TWENTY (20) COPIES
40. OTHER REMARKS OF AN UP-TO-DATE
IN SUPPORT OF YOURUP TO DATE CURRICULUM VITAE FOR POSTS ATTRACTING
SALARY CONHESS 06
APPLICATION………………………………………………………………....
AND ABOVE OR ITS EQUIVALENT USING ALL THE REQUIRED INFORMATION ON THIS FORM AS A
…………………..
(iii) PARAMETER
LETTER OFFOR THE CV. FROM THE CHOSEN THREE REFEREES FOR THOSE ATTACHING
REFERENCE
……………………………………………………………………………………………………………………......
CURRICULUM VITAE
NOTES:
SIGNATUR DATE
E
OFFICIAL USE
ONLY
NAME OF PROCESSING
OFFICER:
DATE
SINGATURE
