Hasan Mansouri Group

Hasan Mansouri Group Job Application Form P.O. Box 5185 Manama Kingdom Bahrain Tel: (973) 17 728 144, Fax: (973) 17 729 976 www.hasanmansouri.com email: [email protected]

Position applied for: Date:

PERSONAL DATA:

Applicant’s Name:

Nationality: Age: Passport# Validity:

Height: Weight: Permanent address:

Tel. Work: Res: Mob: E-mail: Current address:

Tel. Work: Res: Mob: E-mail: Name and address details of contact (Next of Kin) in case of emergency:

Do you have any relatives, friends, or people known to you working within our company, currently or previously (please state their names and relationship to you):

Objective:

EDUCATION:

Degree/Diploma/ Duration of course Subject/ School / Qualifications obtained From To Field University

5 Enclose: 1. Recent photograph (Application will not be processed without a photograph) 2. CV with copies of certificates and testimonials Page 1 of 5 EMPLOYMENT HISTORY: 1 Name and address details Duration of Employment Reason for leaving of Employer From To

Position held, responsibilities, brief job profile:

Achievements:

Please state your salary and benefits

2 Name and address details Duration of Employment Reason for leaving of Employer From To

Achievements:

of 5 EMPLOYMENT HISTORY (continued) 3 Name and address details Duration of Employment Reason for leaving of Employer From To

Achievements:

EXTRA CURRICULAR ACTIVITIES:

REFERENCES: 1 2

Company

Address

Email:

of 5 Questionnaire - Work, medical, and personal:

1 Why do you wish to seek employment with our company and this particular position?

2 What exactly can you do for our company that someone else cannot do?

3 How does this position fit into your future plans?

4 What has been your specific achievement professionally?

5 What do you feel best at?

6 What interests you most in your job?

7 Have you had problems with your previous employer? If so, what was the main problem?

8 What are your weaknesses?

9 Any other factors of your personal circumstances that you would like us to know?

10 Why do you want to work in Bahrain?

MEDICAL [Check Yes or No] NO YES Page 4 of 5 1 Are you now under the care of a doctor? If so what is the condition being treated?

2 Have you ever had a surgical operation? If so, what

Are you taking any medicine(s)? If so, what medicine(s) are you taking? 3

4 Are you allergic or have you had an adverse reaction to: a] Local anaesthetics ? b] Penicillin or other antibiotics? c] Sulfa drugs? d] Barbiturates, sedatives or sleeping pills? e] Aspirin? f] Iodine? g] Distalgesic, Pethedine, or other narcotics?

5 Do you have or have you had any of the following diseases or problems? a] Heart attack, heart disease, or heart surgery ? b] High or low blood pressure? c] Chest pain upon exertion? d] Shortness of breath after mild exercise or when lying down? e] Swelling of your ankles f] Arthritis or painful swollen joints? g] Epilepsy or seizures? h] Diabetes? i] Respiratory problems, emphysema or bronchitis? j] Stomach ulcer or hyperacidity? k] Persistent swollen neck in the neck? l] Abnormal bleeding? m] Sickle cell disease? n] Any treatment for a tumour, growth or cancer? 6 Have you been tested for HIV? 7 Do you have any disease, condition or problem not listed that you think we should know about? 8 Have you ever had Hepatitis? 9 Have you ever had Rheumatic fever? PERSONAL 1 Do you smoke? 2 Do you consume alcohol, if yes how often and quantum? 3 Do you chew tobacco? 4 Are you Homosexual? 5 Were you previously married? 6 Do you have children? 7 Have you convicted and served time in prison? If so, what for? 8 Have you spent any time in police custody? If so, what for? 9 Have you been treated for drug or alcohol abuse?

10 WOMEN: Are you pregnant? 11 WOMEN: Are you nursing?

Declaration by the Applicant: Information provided by me in this Job Application Form is true and accurate. I am fully aware that any information provided by me herein if found to be untrue or inaccurate, the same will result in the immediate termination of my employment with Hasan Mansouri Group and I will be held legally liable as per the prevailing laws of the Kingdom of Bahrain.

(Applicant's name, signature and date

Note: Selected candidate should submit original degree certificates to our office for verification.