NAME

Contact No.:
 WhatsApp:
 Skype ID/link:
 Google Duo Account:
Email address:

INTERVIEWER’S NOTE

 Yrs of exp in HD Clinic/Hospital with ___ bed capacity

 Yrs of exp in other areas
 Foreign license valid until when
 PRC licensed holder
 Attitude ------
 English skills

EDUCATIONAL BACKGROUND:
TERTIARY : COURSE
Name of School
Location
School year: 2000-2004
Date of Graduation: June 2004

SECONDARY: Name of School

Location
School year:
Date of graduation:

LICENSES:

PRC License No. Date of Validity:

Saudi License No. Date of Validity:
Dataflow Reference No.
Prometric Exam (Country/Score): Date Taken:

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
WORK EXPERIENCE

1. NAME OF HOSPITAL, location (latest)

 Company profile / details (Tertiary, Secondary, Private, Public / services provided)
 Accreditation (DOH, ISO, JCI, CBAHI)
 Bed Capacity
 Website: (Optional)
 Others

POSITION:
Department/Unit Assigned:
Inclusive date:

Job Description (department):

 Duties and responsibilities

 Duties and responsibilities
 Duties and responsibilities
 Duties and responsibilities

CASES HANDLED
o
o

PROCEDURE PERFORMED
o
o
o

EQUIPMENT HANDLED
o
o

2. NAME OF HOSPITAL, location

 Company profile / details (Tertiary, Secondary, Private, Public / services provided)
 Accreditation (DOH, ISO, JCI, CBAHI)
 Bed Capacity
 Others

POSITION:

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
 Department/Unit Assigned:
Inclusive date:

Job Description (department):

 Duties and responsibilities

 Duties and responsibilities
 Duties and responsibilities
 Duties and responsibilities

CASES HANDED
o
o

PROCEDURE PERFORMED
o
o
o

EQUIPMENT HANDED
o
o
o

SEMINARS AND TRAININGS ATTENDED:






PERSONAL INFORMATION:
Address :
Date of birth :
Place of birth :
Age :
Gender :
Civil Status :
Citizenship :
Religion :

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
 Height :
Weight :

CHARACTER PREFERENCES:
Name:
Facility:
Position:
Contact No.
Email Address:

Name:
Facility:
Position:
Contact No.
Email Address:

I hereby certify that the above information is true and correct to the best of my knowledge and ability.

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
Please attach your passport

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
Please attach your PRC License (front and back)

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
Please attach your Diploma

Please attached your TOR

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
 CAMOX PHILLIPPINES INC.
Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
Please attach your training certificates (BLS, ACLS or whichever is available that you have)

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
Please attached your Dataflow Report (If applicable)

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
Please attached your Saudi License (if applicable)

Please attached your Prometric Result (If applicable)

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R
 Please attached all your Renal COE (if presently working and cannot provide, please provide
your front and back ID)

CAMOX PHILLIPPINES INC.

Suite 3A, E.P Hernandez Building, 1646 Evangelista St., Bangkal, Makati City, Philippines 1233
Tel. No: (02) 8843-9141 Email: medical@camox.com
www.camox.com
POEA-088-LB-052919-R