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Carer Application Form
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Carer Application Form

Thank you for your interest in working on the Cape Care team. Kindly complete the following application form accurately and honestly. If your application is successful, you will be contacted on your cell phone within 2 weeks. If you do not hear from us within 14 days, that unfortunately means that your application has not been successful. 
*
1.
Name and Surname
*
2.
Your Preferred Name
*
3.
Gender
Female
Male
Other
*
4.
Cellphone Number
*
5.
Email Address
*
6.
Do you live in Cape Town?
Yes
No
*
7.
Are you working anywhere now?[Checkboxes]
Yes
No
*
8.
Have you worked at Cape Care before?[Checkboxes]
Yes
No
*
9.
Do you have an RSA ID Number?
Yes
No
*
13.
Do you have a valid South African Driver's License?
Yes
No
*
16.
Do you have a Care Certificate/Qualification?
Yes
No
*
18.
How long have you worked as a Carer?
*
19.
Are you available to work sleep in shifts (usually 7 days on and 7 days off)?[Checkboxes]
Yes
No
20.
Please Provide 3 contactable work references*
Reference 1
Name of person ：
Relationship to you (e.g Supervisor, Sister in Charge, family member of patient):
Place of Work：
Contact Number：
Reference 2
Name of person：
Relationship to you (e.g Supervisor, sister-in-charge, family member of patient):
Place of Work：
Contact Number：
Reference 3
Name of person：
Relationship to you(e.g Supervisor, Sister in Charge, family member of patient):
Place of Work：
Contact Number：
*
21.
I confirm that I have completed this document accurately and honestly.[Checkboxes]
Yes
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