Armed Forces Hospital
King Abdulaziz Air Base
Dhahran, K.S.A.
POST BASIC NURSING DIPLOMA PROGRAM
APPLICATION
Please indicate the program you are applying for:
Adult Critical Care
Midwifery
Thank you for your interest in this program. Please take a few minutes to complete the application form.
(Please print)
Name___________________________________________
Name of Current Hospital
________________________________________________
Date __________________
For AFH applicant, number of years at Hospital
Registered Nurse________ (Year) __________ (Months)
Number of Years as a Registered Nurse ____________
Current Supervisor _______ __________
Mobile Number _________________________________
Supervisor Contact Number______________________
Email address___________________________________
If you are selected for an interview, please bring with you to the interview:
 3 copies of your curriculum vitae (CV)
 3 Professional letters of reference
 Current BLS certification card – (If not provided with application form)
 Saudi Council registration document and a copy of your family card
Thank you - from the Selection Committee. We wish you the best of luck
Please answer the following questions:
1.
YES NO Comments
Are you a graduate from accredited technical nursing program
or equivalent or Bachelor of Science Nursing program? If yes,
what year did you graduate? What was your GPA?
Year________ GPA _______
2. Are you registered as a BSN with Saudi Council?
3. Do you have a basic knowledge of computers?
4. Are you currently in good health? (a recent physical
examination report is required.)
5. Are you currently certified in Basic Life Support (BLS)? If yes,
please attach a copy of your certification to this application
form.
6.
This program requires study on a full time basis as well as
additional readings and assignments. Have you thought about
the commitment you must make to this program? Please
comment.
7.
The language of study for this program is English. Do you
believe you are competent in English writing and
comprehension? If not, please comment on how you
will improve your language skills prior to the program.

AFH: Armed Forces Hospital
Please Fax Application to: 0133301000 Ext: 1074
To reserve a space please contact: Ms. Diane Whittier Phone: 013 330 7350 or 013 330 2500 Mob: 0530 749 799