Nursing Assistant Program

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    [md-text label="Email"]

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    [md-text label="First Name"]

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    [md-text label="Last Name (Surname)"]

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    [md-text label="Other Name"]

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    [md-checkbox label="Gender"]
    MaleFemale
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    [md-text label="Date of Birth (DD/MM/YYYY)"]

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    [md-text label="Residential Address"]

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    [md-text label="Phone Number"]

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    [md-text label="WhatsApp Number"]

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    [md-file label="Upload Birth Document/Certificate"]

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    EDUCATIONAL BACKGROUND

    [md-text label="Secondary School Name"]

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    [md-text label="Year of Completion (If applicable)"]

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    [md-file label="Upload Secondary School Certificate"]

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    MEDICAL BACKGROUND

    [md-text label="Known Allergies? (Indicate None if its unknown)"]

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    [md-text label="Previous Admissions in Hospitals? (Indicate None if its unknown)"]

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    [md-text label="Previous Surgeries/Operations? (Indicate None if its unknown)"]

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    [md-text label="History of Blood Transfusions and When? (Indicate None if its unknown)"]

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    [md-text label="History of Accidents in the Past? (Indicate None if its unknown)"]

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    [md-text label="History of Head/Chest/Waist Injuries? (Indicate None if its unknown)"]

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    [md-text label="Any Medications Currently? (If yes, Please Specify)"]

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    [md-text label="List Your Hobbies?"]

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    SPONSOR'S DETAILS

    [md-text label="Full Name?"]

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    [md-text label="Sponsor's Relationship?"]

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    [md-text label="Residence Address"]

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    [md-text label="Occupation"]

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    [md-text label="Employer (Indicate if Self-Employed)"]

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    [md-text label="Phone Number"]

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    [md-text label="WhatsApp Number"]

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    TERMS AND CONDITIONS

    A NON-REFUNDABLE N10,000.00 (FIVE THOUSAND NAIRA ONLY) REGISTRATION AND ADMISSION TEST FEE MUST BE MADE WITHIN TWO (2) DAYS FOLLOWING SUBMISSION OF THIS ONLINE APPLICATION FORM TO:

    FCMB PLC.

    7554039013

    ELINOSA MEDICAL & DIAGNOSTICS SERVICES

    (Make sure the Transaction Narration is the NAME OF CANDIDATE)

    SEND EVIDENCE OF PAYMENT TO EITHER: WHATAPP ONLY: +234 813 790 6981

    OR

    VIA EMAIL: elinosamedicare@gmail.com

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    The above details is correct to the best of my knowledge. Submission of this application form subsequent payment for Registration and Admission test does not in any way guarantee my entrance into this program without adequately passing the set requirements.

    [md-quiz label="Prove you're a human by answering the quiz below"]

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    [md-checkbox label=""]
    I have read and understood the above Terms and Conditions.
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    [md-submit]

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