Employer registration form - Elderly Care

Family Registration Form for Elderly Care

Street address *

City *

Province *

Postal Code *

Patient Language *

Employer details

Full name *

Please provide your full name.

Email *

Please provide your email address.

Phone *

Please provide your phone number.

Job position *

Elderly patient name: *

Relationship to the Patient *

Condition of the patient: *

Age of the patient: *

Anything we need to know about the patient?

Package Option

Follow this Link to learn about the packages.

Please note for this position you should choose the domestic worker/gardener packages

Package Options *

Job description *

Tell us about what you're looking for.

Live in/Out? *

Will she/he be required to work overtime? *

If yes, specify how frequently

Personality preference *

Start date *

What is the ideal start date?

Full time / Part time *

If part time, provide exact dates

Age preference *

Indicate an age range

Please select the days required and specify the working hours. *

Estimated Salary *

Employee preferences

Language(s) *

Trained *

CPR and first aid training *

Please list the duties *

Anything you would like to bring to our attention?

I declare that all the information I have added to this form is true and accurate. *

I agree

By ticking the checkbox, I acknowledge that I have read through and accept the terms and conditions below. Terms and Conditions *

Yes

I acknowledge that I am aware of the R400.00 admin fee and placement fees payable to use this service. *

I agree

How did you hear about us? *