FSL INTERNATIONAL MANPOWER

AND PROMOTION S E R V I C E S, I N C.
Lic. No. POEA-221-LB-120914-R
Room 302 & 303, 3rd Floor, MRS Building,
1431 A. Mabini Street Ermita Manila, Philippines 1000
Tel # (632) 524-5551 - 521-2568 Telefax # (632) 524-6337
Website: www.fslinternational.com I E-mail: applicants@fslinternational.com
APPLICATION FOR OVERSEAS EMPLOYMENT
INSTRUCTIONS: DO NOT FILL UP THIS PORTION. FOR FSL RECRUITMENT OFFICER USE ONLY.
1. Please write in block letters. DOCUMENTS REQUIRED COMPLETE INCOMPLETE/REMARKS
2. ALL dates in dd/mm/yyyy 1. Detailed Résumé w/ job description
format. 2. BSN/Diploma
3. Do not leave any blank fields. 3. Transcript of Records (TOR)
4. Use black pen. 4. Related Learning Experience (RLE)
5. PRC Board Certificate
. 6. PRC Card (License)
7. PRC Board Rating Result (itemized)
8. Employment Certifications (ECs)
Passport Size Photo
(whitebackground)

9. Marriage Contract (if applicable)

10. Passport
11. Pictures

Applying for the Position of / Area of Exposure:

PERSONAL INFORMATION
Surname: First Name: Middle Name:

Date of Birth / Age: Place of Birth: Gender:

/
Civil Status: No. of Children / Age(s): Weight: Height: BMI:

/ kg m
Religion: Language Spoken: Nationality:

Passport No.: Date Expiry: Place Issued:

City / Province of Origin: Contact No.'s: E-mail Add:

EDUCATIONAL BACKGROUND
College/University Attended: Degree Attained: Year Graduated:

Professional Licensure Exam: Date Taken:

PRC License No.: Date Registered: Date Expiry:

EMPLOYMENT HISTORY
Name of Hospital/Employer: Bed Capacity / Level: Position Held:

Address: Period of employment:

Tel. Nos. & Email Address:

Name of Hospital/Employer: Bed Capacity / Level: Position Held:

Address: Period of employment:

Tel. Nos. & Email Address:

Name of Hospital/Employer: Bed Capacity / Level: Position Held:

Address: Period of employment:

Tel. Nos. & Email Address:

 ADDITIONAL PERSONAL INFORMATION
Complete permanent Home Address:

FAMILY MEMBERS
Father's Name (Last Name, First Name, Middle Name) Date of Birth:

Mother's Maiden Name (Last Name, First Name, Middle Name) Date of Birth:

Address / Contact No:

BENEFICIARY DATA
Beneficiary Name (Parents / Spouse / Children ): Relationship: Date of Birth:

Address / Contact No:

MEDICAL & OTHER DECLARATIONS

Have you EVER suffered from or been treated for any of the following illnesses?
YES NO If YES, please provide details;
Asthma
Diabetes
Major / Minor Operation
Hernia
Scoliosis
Hepatitis
Breast mass
Chronic ear discharge
High Blood pressure
Epileptic fits or fainting spells
Heart disease
Kidney disease
Mental illness or nervous breakdown
Tuberculosis
Impaired health due to accident
Color blindness / defective Ishihara
Thyroid
Physical disabilities / excess fingers?
Do you have allergies?
Do you have tattoos?
Have you already taken the SINGAPORE NURSING BOARD EXAM? Or have been employed in Singapore? YES or NO?;
If Yes, please provide details;

How did you learn about FSL International Manpower & Promotion Services, Inc.?
1. FSL website 3. Walk-In 5. Referred by:

2. Facebook 4. Jobs Fair / Provincial Recruitment. 6. Others:

I hereby affirm that the information given on this application are true and correct to the best of my knowledge and realize that any
falsification or misrepresentation may result in being disqualified for the position I applied. I further declare that I fully understood all the
details given by the agency in regards to job designation, job description, terms and conditions of my employment and employer's
background. I hereby authorized FSL Int'l Manpower & Promotion Services, Inc. to make reference check to all my past and present
employers on my job performance.

Date: ______________________________________ Signature: __________________________________