Apply Form | BVIHSA

NAME AND ADDRESS

Department Head Email

Supervisor Email

Title

Mr.
Ms.
Mrs.
Doctor
Other

Other Title

Name *

First

Last

Mailing Address

Country of Birth

Immigration Status *

BVIsander
Other

Other Immigration Status

Phone

Cell

Email *

Other Contact Details

COVID-19 VACCINATION STATUS

Vaccination Status

Fully Vaccinated
Partially Vaccinated
Unvaccinated

EMPLOYMENT STATUS

Employment Status

Employed
Unemployed
Student
Self-employed

JOB TYPE

Days available to work

I have no preference
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

I am seeking a

Full-time job
Part-time job
Temporary
Locum
Full or Part-time job

Can you work nights? (if applicable)

Can you work shifts? (if applicable)

Position I applied for

or Do Completed

How did you hear about this position?

Walk-in
Family/Friend
On-line/Newspaper
BVIHSA Website
Other

How did you hear about this position? Other

How many hours can you work weekly?

Date available to begin:

EDUCATION (High School/Trade School)

HS/TS Name of Institution

HS/TS Year Completed

HS/TS Completed Date

HS/TS Diploma

EDUCATION (College/University/Professional)

Name of Institution

Year Completed

Completed Date

Diploma

WORK EXPERIENCE

Company

Name of Supervisor

Contact Number

Address

Start Date

End Date

Job Title

Salary

Job Title

Reason for leaving

OTHER SPECIAL SKILLS/QUALIFICATIONS

Other Special Skills/Qualifications

ADDITIONAL INFORMATION

Have you ever been employed by this organization in the past?

Do you have a driver’s license?

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony?

If Yes, please explain:

REFERENCES

Please include name, contact number and occupation of persons known to you in private or professional life. One must be able to attest to your character; the other work related.
PLEASE DO NOT SUBMIT REFERENCES FROM RELATIVES.

Name

Contact number

Occupation

CHECKLIST & NOTES FOR COMPLETION (MUST be submitted along with this application)

ALL documents must be clean, readable, and copied. DO NOT SEND ORIGINALS
Academic qualifications will be verified before final appointment. Other relevant tests may be required at interview.

Resume
Education
References (as indicated above)
Birth Certificate OR Passport page with picture
Immigration Status (Belonger Card, Naturalization Cert.)
Police Report (Must be in Original)

Upload Resume

Click or drag a file to this area to upload.

Upload Birth Certificate OR Passport

Click or drag a file to this area to upload.

Upload Immigration Status

Click or drag a file to this area to upload.

Upload Education

Click or drag files to this area to upload. You can upload up to 10 files.

Upload References

Click or drag files to this area to upload. You can upload up to 5 files.

Upload Police Report

Click or drag a file to this area to upload.

ACKNOWLEGMENT AND AUTHORIZATION

Acknowledgement and authorization *

I certify that all answers and statements on this application for employment are true and complete to the best of my knowledge.
I do understand that, should this application contain any false or misleading information, it may be rejected or my employment with this organization may be terminated.
I hereby give authorization to BVIHSA to conduct background, educational and employment history check based on the information provided in this application for employment.

Signature of Applicant *

Date *

Medical Services

Psychiatry

Primary Health Care

Iris O'Neal Medical Centre

BVIHSA APPLICATION FORM

NAME AND ADDRESS

COVID-19 VACCINATION STATUS

EMPLOYMENT STATUS

JOB TYPE

EDUCATION (High School/Trade School)

EDUCATION (College/University/Professional)

WORK EXPERIENCE

OTHER SPECIAL SKILLS/QUALIFICATIONS

ADDITIONAL INFORMATION

REFERENCES

CHECKLIST & NOTES FOR COMPLETION (MUST be submitted along with this application)

ACKNOWLEGMENT AND AUTHORIZATION

ABOUT

CARE

PATIENTS & VISITORS

RESOURCES