Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698143735335.pdf (Mauritius)
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APPLICATION FORM EMPLOYMENT OF RETIRED MIDWIFE ON SESSIONAL BASIS MINISTRY OF HEALTH AND WELLNESS Surname (In block letters)……………………………………………………………….…………………………… (Mr/Mrs/Miss) Other Names (In block letters) …………………………………………………………….……………………………………………….

Maiden Name (If applicable):…….………………………………………………….……………………………………………………..

Date of Birth: ……..……Age.….... N.I.D.

No.


Residential Address: …………………………………………………………………………………………………………………... (In block letters) …………………………………………………………………………………………………………………………………………………...

Phone Number: Home ……….………… Mobile …………………… Email Address ……………………....................

Academic and Professional Qualifications: …………………………………………………………………………………………………………………………………………………... ……………………………………...……...……………………………………………………………..…………………………………….. ………………………………………………...…………………………………………………….…………………………………………..
Date of Registration as Midwife with the Nursing Council ………………………...……………...

Grounds of Retirement: (i) Marriage / Special Case /Age/Age Limit (Delete as appropriate) (Tick as appropriate) (ii) Public interest (iii) Medical ground P.T.O 10.

EMPLOYMENT HISTORY (a) Present Employment (if applicable) Post Held Name of Employer Date ……………………….. ………………………… ………….. (b) Previous Employment Post Held Name of Employer Date ……………………….. ………………………… ………….. 11.
Have you ever been subject to criminal proceedings which have resulted in a convict?

Yes/No ……………………………………..

I, …………………………………………………………………………., the undersigned applicant, declare that the 12. particulars in this application are true and accurate and that I have not willfully suppressed any material fact.

Date: …………………………… ……………………………….

Signature of Applicant