Become a Champ
Let's get started! We’d love to welcome you into our family! We need this information to begin reviewing your application.
First, what role are you applying for?
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Caregiver / Healthcare assistant
Qualified nurse (RN, EN)
Companion (a friend to the elderly, mental stimulation, potential driver with own car)
Child Minder (Qualified Child & Youth Care worker)
Name
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First name
Last name
City / Area that you LIVE IN and can provide services in (tick all applicable).
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JHB
PTA
CPT
DBN
PE
OTHER
North
South
West
East
Whole city
City / Area you currently stay in and that you can provide services in.
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Cape Town
Johannesburg
Pretoria
Durban
Port Elizabeth / Gqeberha
Other
City you currently live in
E.g. Cape Town, Johannesburg, etc.
Your Phone number
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Your Email
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example@example.com
Your Date of Birth
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-
Day
-
Month
Year
Date Picker Icon
Next of Kin/Emergency Contact Name
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First Name
Last Name
Next of Kin/Emergency Contact
*
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Important documents
You may complete this section now and choose Continue, or scroll down to Submit & Edit Submission later. We'll send you an email with a link so that you can come back to it at your convenience. IMPORTANT: Your application won't be considered until you submit everything.
Your Level of Nursing
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Registered nurse (RN) / sister
Enrolled nurse / staff nurse
Auxiliary nurse / enrolled nursing assistant
Your ID number (we will check your SANC registration. In case you don't have an ID number, pls input SANC REG NUMBER here)
ID number or SANC reg number
Do you have your own Nurses Kit in order to do home care assessments? (namely Aneroid bp monitor, stethoscope, thermometer, oximeter)
YES, I have the required equipment already.
YES, but it's not complete as per your guideline. I can buy the additional items.
NO, but I am happy to buy via CareChamp for +/- R700 and pay back in 3 tranches over the first 3 assessments.
NO, I don't want to buy equipment.
Are you registered with SANC?
Yes
No
Are you a SETA accredited Assessor, Facilitator and/or Moderator (able to conduct trainings for caregivers?)
Yes
No
Upload relevant nursing certificate(s)
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Choose a file
You can take a picture with your phone.
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Upload copy of your ID (or passport if foreign national)
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You can take a picture with your phone.
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Upload a picture of yourself SMILING (preferably in uniform for nurses and health care assistants). We use this picture on our website (if you are selected) - so a friendly & professional picture will assist in being chosen by clients.
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Upload proof of bank details (to receive payments)
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Letter from bank, bank statement, etc. You can take a picture with your phone. You can also do this at a later stage once we have a suitable opportunity.
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Your income tax number (if you have one)
You can also provide this at a later stage - if we are able to provide you with a suitable opportunity.
Upload relevant course certificate(s)
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You can take a picture with your phone.
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Which academy / institute(s) did you study at (if any) post high school.
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Upload relevant healthcare certificate(s)
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You can take a picture with your phone.
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When did you (or when do you expect to) graduate from your Qualifying Course?
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-
Day
-
Month
Year
Date Picker Icon
Upload proof of hepatitis B vaccine series
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You can take a picture with your phone.
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Upload proof of TB clearance
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You can take a picture with your phone.
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Upload proof of Covid-19 Vaccination
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Upload reference letters
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You can take pictures with your phone.
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Which of the following do you have experience with (select as many as is relevant):
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Dementia care
Physical disability care
Mental disability care
Care for children with disabilities
Palliative care
Assessing basic vital signs
Care of paraplegic and/or tetraplegic patients
Care of schizophrenic patients
Catheter care
Pressure care
Wound care
PEG insertion and feeding
Nanny Care
Other
When did you start practicing in the profession you are applying for?
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-
Day
-
Month
Year
Date Picker Icon
Do you have a valid driver's license?
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Yes
No
Learner's license
Upload copy of driver's license
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You can take a picture with your phone.
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Do you have your own car?
Yes
No
Make and model of car
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You're almost there!
You may complete this section now and choose Continue, or scroll down to Submit & Edit Submission later. We'll send you an email with a link so that you can come back to it at your convenience. IMPORTANT: Your application won't be considered until you submit everything.
ID number (or Passport for non South Africans with residence permit)
Place of birth
City, Country
How would you describe your race or ethnicity?
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Black African
Coloured
Indian
Caucasian
Other
Gender
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Male
Female
Other
Home address
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Street address
Street address contd
City
Province
Postal code
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More about you
This information will help us to match you with the right client/s. You may complete this section now and choose Continue, or scroll down to Submit & Edit Submission later. We'll send you an email with a link so that you can come back to it at your convenience. IMPORTANT: Your application won't be considered until you submit everything.
Do you have children?
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Yes
No
Do you feel comfortable working with clients who have pets?
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Yes
No
What makes you a good caregiver / companion / childminder (depending on what you apply for)?
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Your best day at work you've ever had and what made it so good?
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In what skills area do you feel the most qualified in to be a caregiver / companion or childminder (depending on what you apply for)?
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What makes you most excited about working with seniors / clients with disabilities / patients in general?
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What is something special / unique about you that not many people might know or that might surprise them? Can be something non-relatable to homecare
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Would you feel comfortable providing nanny services?
Yes
No
Please indicate your availability for potential placements (select as many as is relevant)
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Day shift
Night shift
24/7 live-in shift
Weekdays
Weekends
Other / Comments?
Religion
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Christian
Islam
Hindu
Jewish
Traditional African
Not religious
Spiritual
Other
Languages you speak fluently (select as many as is relevant)
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English
Afrikaans
Xhosa
Zulu
French
Other
Average dress size (it will tell us a bit about how strong you are)
Small
Medium
Large
X-large
2XL
3XL
Highest level of education
Grade 10
Grade 11
Grade 12 (matric/NQF Level 4)
College
University
Do you have previous experience in health care? (Not a requirement to be a companion.)
Yes, I worked overseas
Yes, I worked in South Africa
Yes, as a family caregiver
Is there a criminal record against your name / Did you commit an offence resulting in a criminal record?
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YES
NO
How would you describe your personality? I am a/an...
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Entertainer: outgoing, spontaneous, and bubbly
Driver: independent, strong-willed, and thick-skinned
Organiser: serious, systematic, and rather quiet
Listener: soft-hearted, patient, and quiet
Upload a CV (if you have one)
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Upload a Selfie Voice or Video Note intro of yourself with your phone. See the brief here: https://bit.ly/3zctRxu
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Upload a Selfie Voice or Video Note intro of yourself with your phone. See the brief here: https://bit.ly/3zctz9S
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Choose a file
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I confirm that all information I provided is true and correct.
*
YES
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