Attach one

Personal Photo
in this space

Type or write clearly in block letters:

Name of the Facility: SAQR HOSPITAL

A. Personal Information
First Middle Surname
• Full Name: GRACY AMMA
MATHEW
• Gender: ( ) Male ( X) Female
• Marital Status: ( ) Single ( X) Married Other:
_____________
• Date of Birth: 01/12/1952Country of Citizenship: INDIA
• Passport No.: Z 1369444
• UAE Address: → RAK Address: P.O BOX NO 5450 RAK
→ Telephone/ Home: 07-2226411 Mobile: 050-5790701
→ E-mail: gracyammamathew@hotmail.com
• Permanent Address: → Home country: PUTHENPARAMBIL
UTHIMOODU
PTA
→ Telephone/ Home: OO914735227437 Mobile: 00919961748285
→ E-mail: __________________

B. Present Position "Employment

Information"
• Current Job Title: CHARGE NURSE MOH Grade:
3/1
 • Actual Work: STAFF NURSE
• File No.:7473 Date of Appointment:
1-10-1986
• Type of Contract: * Local Foreign Local/
Foreign IC
• UAE/ MOH Registration: R. Number:
____________________________________
Issue Date: ____________________________________
Expiry Date: ___________________________________

• Last Promotion:
Job Title name From: STAFF NURSE To: CHARGE NURSE
Date of Promotion: 29-12-2002
• Change of Contract:
Job Title name From: _______________________ To:
______________________
Date of Contract Changed: ______________

C. Educational Background
Grad.: stands for graduation
• School Leaving Certificate:
9 Years 10 Years 12 Years Other: ____________
Grad. Year _____ Grad. Year1971 Grad. Year 1973 Grad. Year _________

• Professional Education
Diploma 2 years, Grad. Year: ________ BSN, Grad. Year: _______
Diploma 3 years Grad. Year: MSN, Grad. Year:
*Diploma 4 years, Grad. Year: 1979 PH.D, Grad. Year: _______

• Degree other than Nursing:

____________________________________________________
Year of graduation: _______________________

D. Computer Knowledge & Skills

MS Windows, Year: _________ *MS Word, Year: 2007
 MS Excel, Year: _________ MS Access, Year:
________
MS Power Point, Year: _________ Internet, Year:
________
ICDL, Year: _________
• Others:
_____________________________________________________________________

E. Employment Background
• Detail your previous and current employment below:
Duration by years Place of Employment
Area of Position
Country Total Health
Experience Held From To Hospital Other
years Center
MED,SUR,OBS STAFF 2 half
GYNE NURSE INDIA 1978 1981 year X □
STAFF 1 SAQR
OR NURSE U.A.E 1986 1987 year HOSPITAL □
STAFF
MOW NURSE U.A.E 1987 1991 4years X □
STAFF
POOL DUTY
NURSE U.A.E 1991 1992 1year X □
STAFF 10
PN WARD
NURSE U.A.E 1992 2002
years X □
CHARGE
PN WARD
NURSE U.A.E 2002
PRESE-
NT
7 years X □
F. Housing
• Are you staying in MOH Hostel? ( ) Yes ( X)
No
→ Name of the building:
____________________________________________________
→ No. of the floor: __________________________
→ No. of the flat: ___________________________

Staff Development
• Special training courses obtained excluding
competencies program
Name of Course/ Training Duration Place
 From To
IV CANNULATION AND MAY
2 days SAQR HOSPITAL, RAK
MEDICATION 1996
CERTIFICATE OF RECOGNITION
PEDIATRIC (Medic First Aid course 28-7-98 1 day SAQR HOSPITAL, RAK
CPR inclusive)
10TH PERINATOLOGY MEETING 27-3-03 1day HILTON HOTEL, RAK
RAK ANNUAL MEDICAL
24-2-04 27-2-04 RAK CULTURAL CENTRE
CONFERENCE
20-12-
THE BREAST FEEDING COURSE 22-12-05 SAQR HOSPITAL, RAK
05
SWEET KIDS PROGRAMME 27-4-06 1 day LADIES ASSOCIATION, RAK
PAEDIATRIC AND NEONATAL
20-1-07 1 day RAK. HOTEL
SYMPOSIUM
EMIRATES PERINATAL SOCIETY 17-2-07 1 day TAWAM HOSPITAL, AL-AIN
GASTROENTEROLOGY UPDATE 7-8-07 1 day P.H.C RAK
PARAMETERS OF NURSES ROLE
7-8-07 1 day SAQR HOSPITAL, RAK
WORKSHOP
COMMUNICATION WORKSOP 10-8-07 1 day SAQR HOSPITAL, RAK
THE SCIENTIFIC MEETING OF
2-2-08 1 day RAK CULTURAL CENTRE
EMIRATES PERINATAL SOCIETY
WORLD HYPERTENSION DAY
16-5-08 1 day RAK CULTURAL CENTRE
SYMPOSIUM
INFECTION CONTROL SYMPOSIUM 31-1-09 1 day RAK CULTURAL CENTRE

• Postgraduate certificate after appointment: Degree:

_________________
Duration: ___________ Date:____________

Health Information
• Vaccination received after appointment: HBV
Date:2007 Country: U.A.E
Blood group: A NEGATIVE
Any health problem: NIL

Additional Information
• Write down any information you want to add:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
________