subject_line
PRESTIGE SALARY
PROTECTION
SHIELD
EXPRESSION OF INTEREST FORM (EOI)
Agent/Referral Name or Code
*
Incase there is no Agent or Referral, insert "0000"
Name
*
Email
*
Phone Number
*
Salary
*
Industry
*
Aviation
Banking
Conglomerate
Engineering/Construction
Government Ministry Agency & Parastatals
Health Care
Hospitality/Tourism
ICT/Security
Insurance
Manufacturing
Maritime
Media (Public Relation & Advertisement)
Oil and Gas
Other Financial Services
Outsourcing
Power-Electricity (Distribution)
Telecom
Employer/ Company Name
*
Sex
*
Male
Female
Age
*
Marital Status
*
Single
Married
Divorced
Widow/Widower
Grade
*
CEO
Deputy
Director
Senior Manager
Manager
Supervisor
Officer
Support
Qualification
*
School Certificate only
School Certificate with Professional Certificate
OND only
OND with Professional Certificate
Bachelor's Degree/HND only
Bachelor's Degree/HND with Professional Certificate
Masters Degree
Masters Degree with Professional Certificate
PHD
PHD with Professional Certificate
Department
*
ADMIN
HR
MARKETING
OPERATIONS
IT
E-BUSINESS
TREASURY
FINANCIAL CONTROL
INTERNAL CONTROL
INTERNAL AUDIT
No. of job changed in the past 5 years?
*
0
1
2
3
4
5+
Impairment
*
No
Yes
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