Pharmacy / Pharmacy License Form

Photo
Name, Surname Patronymic
Date of birth
Place of birth
Registration address
Residential address
Phone number (residence)
Other number


Previous workplace:

Duties
Name of company, enterprise
Position held
Salary
Employment date
Dismissal date
Reason of dismissal
Awards or fines
Phone number of previsions work


Education:

Date Name of higher school Specialty/academic degree Completed education


Professional skills:

Foreign languages Level
Azerbaijani
English
Russian
Computer knowledge
Do you have any additional work?
Kind of activity
Position
Do you have possibilities to travel regions and abroad ?


Personal details:

Marital status
Conditions of living
Children
Number
Name and date of birth
Spouse
Name, Surname Patronymic
Date of birth
Work place
Residential address
Parents
Father
Name, Surname Patronymic
Date of birth
Work place
Residential address
Mother
Name, Surname Patronymic
Date of birth
Work place
Residential address
Brother/Sister
Name, Surname Patronymic
Date of birth
Work place
Residential address
Brother/Sister
Name, Surname Patronymic
Date of birth
Work place
Residential address
Brother/Sister
Name, Surname Patronymic
Date of birth
Work place
Residential address

Special conditions

Member of war martyr

Participant(veteran) of war

Husbands/wives of officers or soldiers

People who cares of two or more children under 16 years of age

IDP-s and people with refugee status

Women who cares two children under the age of 14

Women who cares two physically disabled children

Women who cares three of children under the age of 14

Men without a wife, who care children under the age of 14, adopted children

Fathers without wives, under the tutelage of which there are three children under the age of 14, adopted children

Yes

No

 

Personal documents:

Document Series of document
Identity card
Passport
Driving license
Military book
Labor book
Card of social insurance
Membership in public organisations

 

Can someone in the Zeytun Pharm Company give recommendations about you?

1 Name/Surname
Position
2 Name/Surname
Position


Conviction:

Do you have conviction?
Does any body of relatives have a conviction?

 

Notes: The employee, in case of hiring, is legally responsible in accordance with the legislation of the Republic of Azerbaijan, the Labor Code and internal regulations.

You are also responsible for the accuracy of the information provided. All data on employment are checked by the company when hiring. Provision of false information can be regarded as a reason for refusal to admit or discharge from work.

I confirm the authenticity of all this information with my signature, and I do not have any complaint that the company"s management has familiarized with the completed form.