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HASKE BUSINESS SCHOOL

Staff Documentation Application Form

Date:

Staff Number:

Designation:

Date of Assumption to Duty:

Surname:

Other Names:

Sex:

Highest Qualification:

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Nationality:

If Nigerian (State): 

L.G.A:

Permanent Address:

Marital Status:

Current E-mail:

Telephone Number:

Mobile:1.

Mobile:2.

SPOUSE:

Surname:

Other Name:

Address:

Email:

Telephone Number:

Children(if any):

Number of Children:

Name of School attended and Address of CHILDREN/WARDS:

Names:

A.

Name of School attended and Address:

Telephone Number:

Mobile:

B.

Name of School attended and Address:

Telephone Number:

Mobile:

C.

Name of School attended and Address:

Telephone Number:

Mobile:

Next of Kin:

Surname:

Other Names:

Address:

Occupation:

E-mail:

Telephone Number:

Mobile 1:

Mobile 2:

Pension Details:

Please Tick as appropriate:

a. Do you belong to any pension scheme?

If yes, please state your:

Pension Administrator:

RSA Number:

Insurance:

Do you have medical insurance?

If yes, please state:

Names of Insurance Company:

Insurance Policy No:

Medical History:

Please Tick As Appropriate:

Are you currently under treatment/management for?

Health Disorder
HIV/AIDS
Pneumonia
Diabetes
Sickle cell Anemia
Tuberculosis
Hypertension
Epilepsy
Corvid-19
Others

NOTE: Attach Medical Report from recognized Clinic/Hospital

Staff Signature and Date

 Signature of Record Officer and Date