Elderly Caregiver Employee Form

Profile Photo *

Please upload a profile picture - SMILING/good light/no pouting/no peace signs

First name *

Please provide your first name.

Surname *

Please provide your last name.

Please provide your email address.

Whatsapp Number *

Please provide your whatsapp number.

City you stay in: (If Pretoria, please specify exactly where) *

Province you stay in: *

Job position *

Work Permit or Asylum *

If you are a foreigner, please load valid working permit this should not have already expired. If it expired please provide waiver slip.

Date of Birth *

Nationality *

How do you understand and speak English? *

Can you speak and understand Afrikaans? *

Emergency contact: Name, phone number and relationship to you. *

How many years of work experience do you have? *

Area you want to work: *

Live In / Live Out *

Please select from below:

From when are you available *

What days are you available? *

Please tell us your preferred week schedule.

Please tell employers about yourself *

With what conditions do you have experience? *

Please describe the health conditions you have worked with while caring for the elderly

Married *

Are you pregnant? *

Do you smoke? *

Do you have a drivers license? *

Are you comfortable working for a family with pets? *

Have you worked and looked after pets before - Feeding//playing *

Notes about pets/is there anything you would like to bring under our attention:

Can you cook? *

Please list all your skills *

Other Alzheimers Dementia Brain and Spinal Injuries Child care (Nanny)

Certificates & Education *

Certificates, diplomas, reference letters, CV, ID, and any other relevant documentation. MOST important to upload here is your CLEAN criminal record check, not older than a year.

Do you have a criminal record? *

You MUST upload your CLEAN criminal record check to your application. Without this your application will be deleted.

What religion do you practice? *

ID Number *

Job History *

Add your work history below. Click + to add more entries.

Job #1

Employer Name

Your Position

Start Date

End Date

Employer Phone

Employer Email

City

State

Ages of children upon hire

Job Description

References *

Add your work references below. Click + to add more entries.

Reference #1

Reference full name

Full address

Reference phone

Reference email

Years known

Under what circumstances do you know this individual?

Please upload all of your documents.

I acknowledge that I have read, understood, and agree to the terms and conditions *

General Terms and Conditions Yes

How did you hear about us? *