Welcome to ClearMedi Healthcare

Joining Letter

I, hereby join duty at the post of at Clearmedi Healthcare w.e.f.

* I declare that I have fully understood the HR policies & other rules & regulations of the organization.

Employee Signature *

HR SPOC

HR Manager

Help us to know you Better – PERSONAL DATA FORM

Personal Information – Capital Letters only

Full Name *

Upload Photo *

📷 Passport size photo | JPG, PNG | Max: 2MB

Upload Signature *

✍️ Clear signature image | JPG, PNG | Max: 1MB

Local Address *

Pin No *

Permanent Address *

Mobile No *

Landline No

Email ID *

Date of Birth *

Blood Group

Real Date of Birth *

Gender *

Male Female Other

Marital Status *

Single Married Divorced Widowed Separated

Date of Anniversary

Nationality *

PAN Card No *

Upload PAN Card *

📷 PAN Card image | JPG, PNG | Max: 1MB

Aadhar Card No *

Upload Aadhar Card *

📷 Aadhar image | JPG, PNG | Max: 1MB

Bank Account No *

IFSC code *

Bank Name & Address *

Emergency Contact Details

Full Name *

Relationship *

Mobile No *

Address *

I hereby declare that all the information furnished above is true to the best of my knowledge and belief. I will do all my duties to the best of my ability while following all the code of conduct of the company and maintaining required level of discipline by the company.

* I confirm that all the personal information provided above is true and accurate

Dependent Details

Dependent 1

Name of Family Member

Date of Birth

Relationship

Is He / She dependent on you?

EMPLOYEE EDUCATIONAL AND PROFESSIONAL DETAILS

ACADEMIC SNAPSHOT

Note: 10th, 12th, and Graduation are MANDATORY * with marksheet uploads

1. Secondary Education: 10th *

From: *

To: *

Specialization: *

University/ Board: *

Upload 10th Marksheet *

📄 PDF, JPG, PNG | Max: 5MB

2. Senior Secondary Education: 12th *

From: *

To: *

Specialization: *

University/ Board: *

Upload 12th Marksheet *

📄 PDF, JPG, PNG | Max: 5MB

3. Graduation *

From: *

To: *

Specialization: *

University/ Board: *

Upload Graduation Marksheet *

📄 PDF, JPG, PNG | Max: 5MB

4. Post-Graduation (Optional)

From:

To:

Specialization:

University/ Board:

Upload Post-Graduation Marksheet

📄 PDF, JPG, PNG | Max: 5MB

5. Other Qualification (Optional)

From:

To:

Specialization:

University/ Board:

Upload Certificate

📄 PDF, JPG, PNG | Max: 5MB

PROFESSIONAL SNAPSHOT

Experience 1

Organization Name:

From:

To:

Designation:

Salary Drawn:

Total Experience:

Upload Experience Letter:

📄 PDF, JPG, PNG | Max: 5MB

Self-Declaration

I have never been convicted of a crime or any offence in any forum / court in any country.

Also, I have not been charged with any offence that is incomplete or awaiting legal action in any forum/ court, nor am I aware of any investigation into my affairs that has the potential to lead to such charges.

Have you ever been convicted? *

Yes No

I hereby notify you that all the foregoing information is true & correct to the best of my knowledge & belief. I accept that if any of the information is subsequently found to be false, I will be liable for disqualification or dismissal from service without any notice.

* I confirm that all the information provided in this declaration is true and correct

Salary decided

Pre-Employment Health Declaration *

Important: This form is issued to identify any health problems or disability that may be relevant to your application.

Do you suffer from any of the following or had a history?	YES	NO
Any physical or mental condition which may affect your work
Any condition that may affect safety of self or others?
Any disability?
Have you ever been rejected or relieved from work due to ill health?
Any other health conditions?

I confirm that to the best of my knowledge, the answers given above are true and correct.

* I confirm that all the health information provided above is true and accurate

EMPLOYEE RIGHTS AND RESPONSIBILITIES

RIGHTS OF EMPLOYEES

Be paid the right wage for the job they do
Protection from unfair dismissal
Sick leave, annual leave, public holidays, family leave
Safe working environment
Health benefits
Confidentiality of their information
Raising complaints and getting appropriate answers

RESPONSIBILITIES OF EMPLOYEES

Arrive at work on time
Dress suitably for the job
Work to the best of their ability
Respect their employers, colleagues and customers
Take care of employer's property
Follow employer's instructions
Obey safety rules
Not discriminate or harass others

* I have read and understood the above rights and responsibilities

Employee Confidentiality / Non-Disclosure Agreement

ClearMedi Healthcare has a legal and ethical responsibility to safeguard the privacy of all patients and protect information that is defined as confidential. Confidential information includes and is not limited to the following information, whether written or oral:

Patient Information contained in manual documentation.
Patient Information stored in the Hospital's computer systems.
Any information provided in any form by whatever name called and includes information pertaining to trade secrets, processes, ideas, inventions (whether patentable or not), computer programs, databases, names and expertise of employees and consultants, any other technical, business, financial, customer and product development plans, supplier information, forecasts, strategies and other related information related to the company.
Any information which if disclosed to public may result in loss to business in any form or hampers the Goodwill of the company.

The information regarded as confidential must be maintained in the strictest of confidence.
On an affiliation with the company, any confidential information to any person should only be disclosed after prior written approval of the authorized personnel.
Information stored in the Hospital's or Hospital's media is accessed only by authorization from the Administration; computer system access is granted only to persons who have been issued user identification codes. Using another associate's user identification code/password or giving your identification code / password to another person, without authorized personnel approval in writing, may result in disciplinary action.
All user identification codes and passwords are confidential and may not be shared or disclosed to any other person. The associate is directly responsible for the accuracy and completeness of data entries, which are entered into the facilities' storage media or Hospital Information System of the company.
Assuring that no associate shall discuss any patient related information in public areas like lifts, waiting areas and stairways.
Accessing any medical or employment record without appropriate need and approval other than as performing your duties as per the Job Description; requesting another associate to access any employment or medical record; allowing another associate to utilize self-password; accessing medical or employment records without having a legitimate reason; using another associate's access code, revealing confidential information of patients, associates or business / financial details, etc constitutes a security violation. All security violations will be reported to and investigated by the appropriate authorities.
This agreement shall be valid during the tenure of your employment. All confidential information shall be handed over at the time of leaving the company.

Failure to abide by this agreement may result in disciplinary action, including dismissal from employment, for gross violations of above.

With my signature below, I acknowledge receipt of a copy of this Confidentiality / Non-Disclosure Agreement and understand my duty to maintain the integrity of the company's confidential information. I acknowledge that I was given a reasonable opportunity to review and negotiate the terms and conditions contained in this Agreement.

* I acknowledge receipt of a copy of this Confidentiality / Non-Disclosure Agreement

ANNEXURE – A, B & C: Format for disclosure

Disclosure of Interests in Entities

Name of entity(ies) where you or your Relative holds direct or indirect interest

Nature of interest in the entity(ies)

Nature of relationship between the Company and the entity(ies)

Name of the Relative and relationship with Relative who holds the interest

Date on which the interest or concern arose/ changed

Disclosure of Relatives in Company

Name of the Relative and nature of relationship

Designation of the Relative

Date on which the interest or concern arose/ changed

Disclosure of Relatives in Relevant Government Department

Name of Relevant Government Department where Relative holds employment

Designation of the Relative

Name of the Relative and relationship

Date on which the interest or concern arose/ changed

Any other details/ disclosure regarding any Conflict of Interest:

The details provided above are true and correct and nothing material has been concealed therefrom.

Induction Confirmation

I certify by my following signature that I have been shown/discussed, reviewed and understood the information provided to me on following topic during my induction program.

Areas	Briefed (Yes/No/NA)
Institution's Mission/Goals
Department functioning & related areas
Staff and management team
Personnel policies
Performance expectations
Health and safety
Radiation safety
Infection Control
Hazardous chemicals and infectious agents
Bio medical waste management
Emergency codes
Conduct during emergency codes

* I confirm that I have been briefed on all the above topics during my induction program

I have been made aware of who to ask and/or where to look should future questions arise. I understand that violation of ANY safety rule or Hospital policy is unacceptable, requiring corrective & progressive disciplinary action.

APPENDIX C: UNDERTAKING

This is to acknowledge that I have received, read, and fully understood all the contents of the Anti-Bribery and Anti-Corruption Policy ("ABAC Policy") of ClearMedi Healthcare Private Limited ("Company").

* I acknowledge and agree to the above ABAC Policy undertaking

CMH Reference Check Form

Note: This section collects reference information for employment verification purposes.

Reference Check For (Candidate Name) *

Information Furnished by *

Reference 1

Name

Date

Designation

Organization

Mobile Number

Reference 2

Name

Date

Designation

Organization

Mobile Number

Questions

Questions	Reference 1	Reference 2
1. How long have you known the applicant?
2. Responsibilities of the candidate while working at your company?
3. What were his/her strong points on the job?
4. Are there any specific areas where improvement was required?
5a. Attendance Record
5b. Ability to handle pressure
5c. Ability to take on responsibility
5d. Ability to meet deadlines
5e. Degree of supervision needed
5f. Integrity / Commitment
5g. Leadership Skills
6. How will you evaluate his/her overall performance?
7. Why did he/she leave the organization?
8. Given the opportunity would you re employ him/her?
9. Is there anything else you would like to add about the candidate?

Reference Check Done By

Signature

Final Declaration & Signature

Final Declaration:

I hereby solemnly declare and confirm that all information provided in this Employee Joining Kit is true, accurate, and complete to the best of my knowledge.

Declaration Date *

Signature *

Joining Letter

Help us to know you Better – PERSONAL DATA FORM

Personal Information – Capital Letters only

Emergency Contact Details

Dependent Details

Dependent 1

EMPLOYEE EDUCATIONAL AND PROFESSIONAL DETAILS

ACADEMIC SNAPSHOT

1. Secondary Education: 10th *

2. Senior Secondary Education: 12th *

3. Graduation *

4. Post-Graduation (Optional)

5. Other Qualification (Optional)

PROFESSIONAL SNAPSHOT

Experience 1

Self-Declaration

Pre-Employment Health Declaration *

EMPLOYEE RIGHTS AND RESPONSIBILITIES

RIGHTS OF EMPLOYEES

RESPONSIBILITIES OF EMPLOYEES

Employee Confidentiality / Non-Disclosure Agreement

ANNEXURE – A, B & C: Format for disclosure

Disclosure of Interests in Entities

Disclosure of Relatives in Company

Disclosure of Relatives in Relevant Government Department

Induction Confirmation

APPENDIX C: UNDERTAKING

CMH Reference Check Form

Reference 1

Reference 2

Questions

Final Declaration & Signature

✓ Form Submitted Successfully!