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Alpha Mead's Pre-Employment Doc. (New)

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AMG/CSD/HRA/PEF/02

ALPHA MEAD GROUP


It is the policy of this organization to employ staff strictly based on an individual’s professional qualifications. Selections are made without
regard to any ethnic group, religion, sex, state of origin, and/or age.

PERSONAL DETAILS
(Kindly complete this column in its entirety)

Name: DOB:
Address: City:
Mobile No.: Email Address:
Marital Status Nationality:
Means of
Identification:
Have you ever been convicted of Yes { } No { } If employed, are you willing to allow Yes { } No { }
any Alpha Mead to conduct a background
crime in or outside of this country: check on your profile?

POSITION APPLIED FOR


How did you learn of the Date Available to start:
Vacancy?
Salary Expectation:
Current Job Benefits 1
(Non-monetary or Monetary Benefits
that come with your employment)
2
3
4
5

EDUCATIONAL QUALIFICATIONS
S/N Course of Study Class of Degree Year Completed Institution Attended

PROFESSIONAL MEMBERSHIP
What professional membership organization is relevant to the job you belong to?
S/N Course of Study Institution Date Obtained

Alpha Mead Group…We Care


EMPLOYMENT RECORDS
Please list your employment history starting with your most recent first.
Previous/Current Employer 1
1
Date Engaged From:
Address
To:

Position Held Salary Earned:


Supervisor’s Name & Role Email Address:
Phone No.:
Reason for leaving May we contact them?
Yes { } No { }
Do you have any loan Yes { } No { } Amount:
commitment to your Employer?
2 Employer 2

Address Date Engaged From:


To:
Position Held Salary Earned:
Supervisor’s Name & Role Email Address:
Phone No:
Reason for Leaving May we contact them?
Yes { } No { }
Do you have any loan Yes { } No { } Amount:
commitment to your Employer?

REFERENCES

Do you agree to have referees contacted in relation to this application? Yes No

(NB: Reference checks will be conducted legally in an ethical manner and all information derived will remain confidential.)

Please provide details of three people who can speak on your behalf regarding your work history.

Name Title Organization Contact Details (Email)

DECLARATION
I declare that to the best of my knowledge, the information provided is genuine. In the event of this application, I
understand that inaccurate, misleading, or untrue statements or knowingly withheld information may result in
termination of employment with Alpha Mead Group. In conclusion, I agree that this application does not
constitute an offer of employment.

…………………………………….. …………………………………….
Name Signed & Date

Alpha Mead Group…We Care

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