the application Title Mr Mrs Miss Other First Name Last Name House Name or Number Town Nationality ID Number Phone Number Ecocash Number Country Email If you hold a Zimbabwean Driver's Licence Enter ID Below POSITION APPLIED FOR DR - GENERAL PRACTITIONERDR EMERGENCY/TRAUMADR HIVDR - CARDIACDR NEUROLOGYDR DENTISTDR ONCOLOGYDR GENERAL MEDICINE DR PSYCHIATRIST GENERAL NURSEMENTAL HEALTH NURSEMIDWIFECOMMUNITY NURSE PHYSIOTHERAPIST DIETICIAN HOMECARE SUPPORT WORKERHEALTH CARE ASSISTANT OTHER OTHER POSITION PROFESSIONAL REGISTRATION/PIN NO DOCTORS RGN/RMN/MIDWIVES SPECIALIST HEALTH PROFESSIONALS DETAILS OF ANY REGISTRATION RESTRICTIONS, CAUTIONS OR SUSPENSIONS/DISCIPLINARY ACTION University QUALIFICATION From To DID YOU GRADUATE? YESNO University QUALIFICATION From To DID YOU GRADUATE? YESNO ADDITIONAL PERSONAL QUALIFICATIONS COMPANY Phone Address Job Title Period Of Employment Reason Of Leaving SECOND EMPLOYMENT Phone Address Job Title Period Of Employment Reason of Leaving HAVE YOU EVER BEEN DISMISSED FROM EMPLOYMENT? YESNO iF YES GIVE DETAILS FULL NAME OF REFEREE RELATIONSHIP COMPANY PHONE Email Address FULL NAME OF REFEREE RELATIONSHIP COMPANY PHONE EMAIL MAY WE TAKE REFERENCES PRIOR TO INTERVIEW, IF REQUIRED? YESNO AVAILABILITY AREAS YOU COVER ARE YOU CURRENTLY BOUND OVER OR DO YOU HAVE ANY CURRENT UNSPENT (RECENT) CONVICTIONS THAT HAVE BEEN ISSUED BY A MAGISTRATE COURT OR HIHG COURT IN ZIMBABWE OR IN ANY OTHER COUNTRY? YESNO IF YES, PLEASE ATTACH DETAILS OF THE ORDER BINDING YOU OVER AND/OR THE NATURE OF THE OFFENCE, THE PENALTY, SENTENCE OR ORDER OF THE COURT, AND THE DATE AND PLACE OF THE COURT HEARING. HAVE YOU EVER RECEIVED A POLICE CAUTION, REPRIMAND OR FINAL WARNING? YESNO F YES, PLEASE ATTACH DETAILS OF THE CAUTION, REPRIMAND OR FINAL WARNING, INCLUDING THE DATE AND THE REASON ADMINISTERED. DISCLAIMER AND AGREEMENT I CERTIFY THAT MY ANSWERS ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AGREE TO COMPLY WITH THE CURRENT HEALTH & SAFETY AT WORK ACT. I UNDERSTAND THAT MY APPOINTMENT IS SUBJECT TO THE RECEIPT OF A MINIMUM OF TWO SATISFACTORY REFERENCES AND IS SUBJECT TO DBS DISCLOSURE AT ENHANCED LEVEL. I AUTHORISE CMHEALTHCARE TO MAKE ANY OTHER ENQUIRIES THEY MAY FEEL NECESSARY TO SUPPORT MY APPLICATION. I AGREE TO RESPECT THE CONFIDENTIALITY OF PATIENTS AND CLIENTS AND ANY OTHER INFORMATION I MAY HAVE ACCESS TO AT ALL TIMES. I UNDERSTAND THAT I CAN ACCESS THE POLICIES AND PROCEDURES AND STAFF HANDBOOK VIA THE INTERNET SHOULD MY APPLICATION BE SUCCESSFUL AND IN ADDITION I WILL BE FURNISHED WITH THE FOLLOWING PAPER DOCUMENTS UPON MY APPOINTMENT: STAFF HANDBOOK, PROCEDURES LETTER AND TERMS OF ENGAGEMENT. PAPER BASED COPIES OF ALL POLICIES ARE AVAILABLE ON REQUEST. IF THIS APPLICATION LEADS TO EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION IN MY APPLICATION OR INTERVIEW MAY RESULT IN MY RELEASE. ADDITIONAL DOCUMENTS Send