Job Application Form Page 4
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4PRIVATE & CONFIDENTIAL
Annex Ai
REFEREES
1) Name
Occupation & place of work
Address
Contact numbers
2) Name
Occupation & place of work
Address
Contact numbers
I declare that all information given is true to the best of my knowledge and I hereby consent to have my
name and particulars sent to MSF for security screening. I acknowledge that if any part is found to be false,
I will be disqualified, or, if already appointed, it will result in my dismissal.
Signature: ___________________________________
Date: ___________________
FOR OFFICIAL USE ONLY
NAME OF INTERVIEWERS
INTERVIEWER/S REMARKS
1)
2)
3)
4)
5)
OVERALL RATING
1-10 (10 being the highest)
Please circle
SELECTED
KIV
REJECTED
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CENTRE
DATE JOINED
SALARY OFFERED (Per Month)
JOB GRADE
…………………………………………..……
Approved By : Executive Director
* Delete where applicable
Aug 2013
Singapore Children’s Society
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