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PERSONAL PROFILE|
Full Name (as
per I.C.):
NRIC Number:
Age:
Marital
Status:
Gender: Female
Nationality: Malaysian
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Date of
Birth:
Height
Weight:
Religion:
BMI
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Mobile Number:
E-mail
Address:
Address:
Point Of Hire :
Name of Emergency
Contact (Relationship):
Contact Number of
Emergency Contact:
EDUCATION/QUALIFICATIONS
Please list all relevant qualifications including high
school qualification (SPM), professional qualification (diploma, degree,
Masters), post basic certification, etc. (Delete
the instructions (in green) after completing this section)
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Date
Qualification Obtained
(Start &
End Dates)
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Qualifications
Obtained& Name of College
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Julai 1998-julai 2001
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Diploma in Nursing
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Julai 2008- julai 2009
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Post Basic Certification: Midwifery
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Jan 1993-Jan 1994
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Malaysian Certificate of Education (SPM)
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REGISTRATION WITH
PROFESSIONAL BODIES
Please list your active registrations (e.g. Nursing
Board, Medical Board, etc.), date obtained as well as the related registration
number(s).
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Date Of
Registration
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Registration
Body
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Registration
Obtained
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Registration
No.
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30/07/2001
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STAFF REGISTERED NURSE
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MALAYSIAN NURSING BOARD
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46854
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27/07/2009
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MIDWIFERY
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MIDWIVES BOARD NURSING
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20747
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Employment History
CURRENT
Employment
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Date
Employed
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:
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[start date] –Current
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Position
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:
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Unit
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:
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No of
beds in Unit
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:
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beds
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Nurse
to Patient Ratio
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:
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1 :
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Hospital
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:
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No. of
beds in Hospital
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:
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Duties & Responsibilities:(indicate daily nursing duties performed and
responsibilities including any supervisory duties e.g. team leader, in charge
duties, preceptor, acting etc.)(Delete the instructions (in green) after
completing this section)
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§
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Type of Cases & Patients Encountered: (list
cases received and if patients are only adult, peds, mixed, combined)(Delete
the instructions (in green) after completing this section)
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§
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Type of Equipment Used:
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§
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Special Procedures Performed: (Indicate any special procedures performed or
assisted Doctorswith (E.g. lumbar puncture, insertion & removal of CVP
lines, Liver biopsy, Intubation, Extubation, Bone Marrow aspiration &
biopsy etc.)(Delete the instructions (in green)after
completing this section)
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§
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Other Skills:(Indicate any other skills or
experienced gained; e.g. quality process improvement, commissioning
experience, accreditation committee (audits/surveys) projects or research
groups, etc.)(Delete the instructions (in green) after
completing this section)
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§
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Previous Employment(Please list down all previous employment)
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Dates Employed
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:
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to
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Unit
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:
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Hospital
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:
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No. of beds in Hospital
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:
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Description of Ward/Unit: (indicate speciality area, number of beds and nurse
to patient ratio)(Delete the instructions (in green) after
completing this section)
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Duties & Responsibilities:(indicate daily duties performed and
responsibilities assigned including any supervisory duties e.g. in charge
duties, preceptor, acting etc.)(Delete the instructions (in green) after
completing this section)
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§ Not required if similar to current duties
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Employment History
Should you have more than two (2) employments
in different unit and/or hospital, please complete the following
START with your CURRENT to previous
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DURATION
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PLACE OF WORK
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POSITION
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UNIT
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YEARS OF EXPERIENCE
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Total Number of Years of Experience
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:
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Specialty
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:
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Courses Attended –
Recent 2 years(Pleasespecify only those which are relevant to
the position applied)|
Date Attended
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Name of
Course/Seminar/Workshop
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REFERENCES
Please provide contact details of 2 clinical referees.
These MUST be people who have managed you in a clinical setting. Please make sure you ask their permission
first and provide the following details:
·
Name
·
Title
·
Hospital Name & Ward
·
Phone Number
·
E-mail Address
