APPENDIX 4
LaoJee 37119015
APPLICATION FORM
INSTRUCTIONS: It is important that you fill out all sections of this application completely and to the best of your
ability. Your application will be used as part of the examination process and, therefore, should represent your best
effort. All information provided herein is kept confidential
PERSONAL DATA:
Father’s Name: zahoor ahmed khan
Gender: male
CNIC no: 421011-384997-7
Date of Birth:20-11-1976
Nationality: Pakistani
Marital Status:single
Husband’s Name:
Religion: Islam
No of Children:
CONTACT INFORMATION :
Postal address:karachi,Pakistan
Mobile:
00966
Work Tel:
Most ideal contact information to reach you: mobile
Availability to commence employment :3/4 months
Home Tel:
Email address:
EDUCATION / QUALIFIC ATION:
Name of School/University
Year
Education/Qualification
Graduated
Obtained
Karachi cambrige school
1992
matric
Govt college for men
1994
intermediat
Govt jamia millia polytechnic institute
1997
Diploma
of
associate
engineering in biomedical
technology
LANGUAGE PROFICIENCY :
Please write: (√)
Languages
Fair
Good
Excellent
English:
[
]
[
]
[ *
]
Urdu:
[
]
[
]
[ *
]
Arabic:
[ *
[
]
[
]
Others:
[
[
]
[
]
]
]
TRAINING/SEMINARS AT TENDED:
____________________ ____________________ ____________________ ____
1- BASIC TRAINING PROGR AME ON HEMODIALYSIS MACHINE AK -95
/ AK-200 CONDUCTED BY GAM BRO SINGAPORE
( BY MR .WILLI
CHIONH )GAMBRO SERVI CE MANAGER S.E.A
/ SUB CONTINENT
SINGAPORE
2 Technical training for gambro AK-95 S Hemodialysis equipment By G. Sivagurunathan ) Service
Manager ,Gambro , India
3-Operational and Clinical Aspects on Gambro CRRT [ Prisma ]( By Clinical Specialist ,Gambro ,
Philipine )
4-Operational and Clinical Aspects on ETT Machine alongwith Treadmill ( By Mr Saleem Hassan ,
President , Pulse Biomedical )
One day workshop on Intra Aortic Balloon Pump of Arrow, USA at Aga Khan University Hospital,
Karachi [Pakistan]
Certificate of Cardiopulmonary Resuscitation (Basic Cardiac Life Support –BCLS)
From Saudi German Hospitals Group and Saudi Heart Association and American Heart Association.
Active Participation for Member, Facility Management and Safety
(FMS Chapter) for the pre-accreditation preparation the significant factor in achieving
JOINT COMMISSION INTERNATIONAL (JCI) chapter.[Saudi German Hospital,Riyadh]
______________________________________________________________________________
______________________________________________________________________________
SPECIAL SKILLS: (PLEASE LIST DOWN YOUR SPECIAL SKILLS, KNOWLEDGE AND ABILITIES THAT YOU FEEL
ARE APPLICABLE TO THE POSITION FOR WHICH YOU APPLIED)
Cardiac Monitor [Spacelabs / GE]
Deffibrillators
ECG Machine
NIBP/Vital Sign Monitor [Dinamap]
Cardiac Monitor[Agilent]
Dialysis Machine [Gambro]
CRRT Machine PRISMA [Gambro, Italy]
CRRT Machine MULTIFILTRATE [FRESENIEUS]
Intra Aortic Balloon pump [ARROW INTL]
ETT Machine [Pulse Biomedical, USA]
Dermatology Laser [ Cynosure ]
Sterilizers (Getinge,Liquex)
Very well familiar with all types of Hospital Equipments
____________________ ____________________ ________________
__HEMODIALYSIS____________________________________________________________
________________
______________________________________________________________________________
EMPLOYMENT HISTORY ( P R E S E N T
From
To
2001
2005
Job Title:
Employer
T O P A S T ):
Liaquat National Hospital
:
Telephone No.
Address: Stadium Road Karachi
Biomedical Engineer
Beds\Head Count
Details:
700 Beds
Reporting
Bio medical
toManager
Nature of work and responsibilities: maintain service manual, attend
the complain from the assign department , repoting to manager
biomedical , assign department Renal ,RO System, Nephro ICU ,
CRRT Machine ,ETT Machine
Last Salary:
Reasons for leaving: for higher study
From
To
Employer: Saudi German Hospital Group Riyadh,
2008
2009
Saudia
Job Title: Biomedical
Telephone No.
Address: Qasim Road Riyadh,Saudia
Technician
Beds\Head Count 300
Details:
Beda
Reporting to: Manager
Nature of work and responsibilities: : maintain service manual, attend
Maintenace
the complain from the assign department , repoting to manager
Maintenance , assign department Renal ,RO System, CSSD , OPD
Clinics ,Deffibrillators ,Pediatric Icu , CRRT Machine
Last Salary: 3500 SR
Reasons for leaving: at that time my mother was very seriously ill and
she was calling me. So I leave the hospital and come back to
Pakistan. After that she has been died.
From
To
2010
UNTILL
Employer: xxxxxx Tabuk , Saudia
NOW
Job Title:
Biomedical
Address: Tabuk Saudia
Telephone No.
Technician
Beds\Head Count 350
Details:
Beds
Reporting to: Manager
Nature of work and responsibilities: maintain service manual, attend
Biomedical
the complain from the assign department , Finish the complain in the
assign department otherwise bring the equipment in biomedical
department if parts required order to the company with the permission
from manager biomedical ,attend the complain from any department if
the assign technician is not available, reporting to manager
Biomedical , assign department Renal ,RO System, all general
equipments , Cardiac Monitors ,
Last Salary: 4000 SR
Reasons for leaving:
CURRENTLY WORKING IF THE HIGHER SALARY OFFER
Number of Procedures Performed in Specialty / Sub Specialty: (Brief)
(For Physicians Only)
Procedure
Number
REFERENCES
List three references who can attest your character and professional skills. Please do not include
your friends and relatives.
Do you authorize xxxxxx to contact the above given references? Yes [ * ]
No [ ]
UNDERTAKING
I hereby certify that all information I have made in this application are true and correct, and agree that any
misrepresentation or false information will result to cancellation of my application for employment, or immediate
dismissal from the Company if I have been employed.
Signature: _________________________
Date: 12 March 2011