Membership Application Form
OCR Upload
1. Personal Information
Name (Family Name, Given Name, Middle Name)
Date of Birth
Sex
Male
Female
Current Address
Permanent Address
Email Address
Landline #
Mobile Phone #
Place of Birth
Marital Status
Emergency Contact
2. Employment Record with DOH
DOH Agency
Address
Period of employment:
Start Date
End Date
3. Highest Educational Background
School
Degree/Course Attained
Year Graduated
4. Current Engagement
None
Working Full-time
Working Part-time
Civic Activities
Others (Specify):
5. Key Expertise
Research
Training/Teaching/Facilitation
Monitoring & Evaluation
Statistics
Finance Management
Procurement & Supply Chain
HR/Personnel Development
Policy Development
Planning
Project Management
Project Proposal Development
Digital Health
Administration
Others (Specify):
Indicate specific field:
Clinical Care
Public Health
Health Regulation
Health System
Others (Specify):
6. Other Skills
a. Special Skills
b. Hobbies
7. Committees
Membership & Training Committee
Advocacy Committee
Finance Committee
Project Committee
Ad Hoc Committee
Others (Specify):
Valid ID Upload
Upload a Valid ID
Please upload a clear image of your valid ID.
Signature
Signature of Prospective Member
Clear
Back to Home
Submit Application
Choose Input Method
Please choose how you want to fill the membership form:
Upload Image for OCR
Manual Input
Face Validation
Stored Face Reference
Capture Your Face
Validate Face