Beruflich Dokumente
Kultur Dokumente
PERSONAL DETAILS FAMILY NAME: DATE OF BIRTH NATIONALITY PASSPORT NO. DAY OTHER NAMES: MONTH YEAR
PRESENT ADDRESS TEL: PERMANENT ADDRESS TEL: MARITAL STATUS (Please encircle) SINGLE MARRIED FAX: DIVORCED WIDOWED FAX:
OCCUPATION OF SPOUSE: DATE OF BIRTH: CHILDREN DATE OF BIRTH: DATE OF BIRTH: SEX: SEX: SEX:
(V01)
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LANGUAGES GOOD ARABIC ENGLISH GERMAN FRENCH OTHERS SPOKEN FAIR POOR GOOD WRITTEN FAIR POOR UNDERSTANDIN GOOD FAIR POOR
(Please encircle)
YES
NO
(V01)
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GENERAL INFORMATION (Please encircle) Have you ever been discharged from employment because your conduct and work was not satisfactory? Have you ever been arrested and convicted of a crime? YES NO
YES
NO
May we ask your present employer for references regarding your qualifications and character? Have you been previously employed in the U.A.E? If so, do you have a release from your previous employer? HEALTH Height (Metres) ______________ Weight (Kilos) ________________ Number of days sick in the last 12 months _____________________ Medical History Have you ever suffered from any of the following: Back problems Skin disease Food poisoning, dysentery, salmonella Stomach or bowel problems Typhoid / Paratyphoid
YES
NO
YES
NO
If YES to any of the above, explain briefly ______________________________________ _________________________________________________________________________ Have you ever suffered any serious injuries, illness or disease? Please explain: _____________________________________________________________________ Do you presently have any medical condition that might prevent you from fulfilling your responsibilities (e.g. pregnancy, poor sight or hearing)? Please explain:
All successful applicants are required to undergo through medical examination, affirming details furnished in the application.
(V01)
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DATE TO/FROM D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__ D__ M__ Y__
NET SALARY
What else would you like to tell us about yourself that will support your application? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ PERSONAL REFERENCES NAME
POSITION
ORGANISATION
CONTACT DETAILS
Details of family members employed with Jumeirah International __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ DECLARATION I declare that the information furnished herein is true to the best of my knowledge and understand that if any of the statements in this application are found to be untrue, it may affect my employment with Jumeirah International.
Date:
Signature: _________________
(V01)
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Name Position Complete Present Address: Contact No.(s) Complete Permanent Address Hometown): Contact No.(s) COLLEAGUES DEPENDANTS DEPENDENTS (Spouse and Children) 1. SPOUSE 2. CHILD 1 3. CHILD 2
ID No. SBU/Department
FULL NAME
SBU / DEPARTMENT
BANK ACCOUNT DETAILS (FOR COLLEAGUES WITH ACTIVE UAE ACCOUNTS) Account Type Bank Name Account No. Bank Branch
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The following information is confidential and for use by the Human Resources and Medical Services departments only.
PERSONAL INFORMATION Full Name DOB ____________________________________________________________ ______________ Age _____________ _____________ Sex _____________
PRESENT MEDICAL INFORMATION Known Allergies _______________________________________________________ _______________________________________________________ _______________________________________________________ Have you ever received any of the following vaccinations? Yes Measles Polio Tuberculosis Tetanus No Hepatitis A Hepatitis B Cholera Yellow Fever Yes No Influenza Mumps Rubella Other Yes No
Yes No Are you currently taking any medicines? If yes, please provide details _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Yes No Have you ever been hospitalized? If yes, please provide details ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Yes No Have you had any operations or surgery? If yes, please provide details _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
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PAST MEDICAL INFORMATION Have you ever had any of the following diseases? Yes Chickenpox Measles Mumps
German Measles
Yes
Yes
No
Do you currently have or have been previously treated for any of the following conditions? Yes Anemia Arthritis Asthma Tumors/Cancer No Diabetes High Blood Pressure Heart Problem Epilepsy or seizures Yes No Stroke Depression Mental Disorder Yes No
Do you presently suffer from or have you previously experienced any of the following problems? Yes No Yes No Yes No Back, spine, Frequent headaches Knee problem neck Broken bones Migraines Pneumonia Ear problem Eye problem Fainting Blackouts Heat/sun sensitivity Hernia Low blood pressure Kidney problems Skin disease Stomach Ulcer Nose/Sinus problem Throat infections
If yes, please provide details _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ I declare to the best of my knowledge, the above information is true and correct. Signature __________________________
Medical History Form (V01)
Date ____________________
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PROFESSION : (if shown in passport) PERMANENT ADDRESS (including phone no. & fax no.) :
PRESENT ADDRESS : (Including phone no. & fax no.) PREFERRED AIRPORT : (Nearest to your Home Destination)
FATHERS DETAILS FIRST NAME NAME NATIONALITY RELIGION : : : MIDDLE NAME LAST NAME
FIRST NAME
MIDDLE NAME
LAST NAME
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FIRST NAME
MIDDLE NAME
LAST NAME
FIRST NAME
MIDDLE NAME
LAST NAME
FIRST NAME
MIDDLE NAME
LAST NAME
FIRST NAME
MIDDLE NAME
LAST NAME
Please note that the validity of your passport must be for a minimum period of twelve months otherwise any application for a visa will be rejected.
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Jumeirah provides insurance cover for you in the event of death, permanent or temporary disablement. Details are available from the Human Resources Departments. It is important that you nominate to whom you would like this payment to be made. I hereby nominate the person(s) to receive payments under the Company Insurance Policy in the event of my death. NAME OF NOMINEE PROPORTION OF No. RELATIONSHIP (BENEFICIARY) BENEFIT (%) 1. 2. 3. 4. 5. In the event of any of the beneficiaries predeceasing me prior to modification of this form by me, the amount, which cannot be disbursed to such deceased person; may be divided amongst the remaining beneficiaries in a manner that maintains the same proportion as stipulated above. I shall be wholly responsible for any modifications made by me to this nomination. CONTACT PERSON(S) IN CASE OF EMERGENCY: (Relative or Guardian) RELATIONSHIP:
NAME:
RELATIONSHIP:
RELATIONSHIP:
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