Local Interim Caregiver
Name (as per IC)
*
Address
*
NRIC/FIN No.
*
Date of Birth (DD/MM/YYYY)
*
/
Day
/
Month
Year
Date
Email Address
*
example@example.com
Mobile No.
*
Nationality
*
Singapore Citizen
Singapore Permanent Resident
Others (please specify)
Other Nationality
*
Gender
*
Male
Female
Gender
Marital Status
*
Single
Married
Separated
Divorced
Widowed
Marital Status
Religion
*
Catholic
Christian
Buddhist
Muslim
Hindu
Sikh
Others (please specify)
Other Religion
*
Height (cm)
*
Weight (kg)
*
Years of Experience
*
Do you have a Professional Indemnity Insurance?
*
Yes
No
Are you a
*
Registered Nurse
Enrolled Nurse
Registered Midwife
Others (please specify)
Specify Other Care Related Profession
*
Please select region of your home address:
North (Admirality, Kranji, Woodlands, Sembawang, Yishun, Yio Chu Kang, Seletar, Sengkang)
South (Holland, Queenstown, Bukit Merah, Telok Blangah, Pasir Panjang, Sentosa, Bukit Timah, Newton, Orchard, City, Marina South)
East (Serangoon, Punggol, Hougang, Tampines, Pasir Ris, Loyang, Simei, Kallang, Katong, East Coast, Macpherson, Bedok, Pulau Ubin, Pulau Tekong)
West (Lim Chu Kang, Choa Chu Kang, Bukit Panjang, Tuas, Jurong East, Jurong West, Jurong Industrial Estate, Bukit Batok, Hillview, West Coast, Clementi)
Central (Thomson, Marymount, Sin Ming, Ang Mo Kio, Bishan, Serangoon Gardens, MacRitchie, Toa Payoh)
Select Availability
*
Full time
Part time/Flexi time
Indicate preferred schedule
Bank Account Details
Bank Name
Account Type
Account Number
PayNow (if available)
Education and Work Experience
Highest Level of Education
*
Rows
Institution
Qualification
Year Graduated
1
2
Licensure/Certification
Rows
Institution
Title
License No.
Expiration Date
1
2
Work Experience
*
Skills
Select all skills which you are competent.
Skill Level 1: Assistance with ADLS/Personal Care tasks
Bathing
Feeding (oral)
Mobility
Toileting
Grooming (brushing teeth, cleaning dentures, shaving, hair trimming)
Lifting, Transferring, Positioning of Client
Catheter care and draining bag
Changing of clothes, undergarments, soiled sheets
Skill Level 1: Assistance with instrumental activities of daily living (IADLs)
Assisting in light housekeeping/laundry
Simple errands/grocery shopping
Skill Level 1: Monitoring of vital signs
Temperature
Blood pressure
Pulse
Respiratory
Weight
Hypo count monitoring and charting
Skill Level 2: Skills level 1 + Higher care tasks
Assistance with medication
Assistance with Nebuliser
Applying of cold compress
NGT/PEG feeding
Care of PEG and dressing
Care of urinary catheter and drainage system
Perform simple maintenance exercises as prescribed by registered therapist
Simple wound dressing
Skill Level 3: Skills level 1 + Level 2 +
Stoma care
Tracheostomy Care
Suctioning
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Training Certificates and/or Licensure ID
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Declaration
I agree that Aseana Caregivers Pte Ltd should not be held responsible for the nursing services rendered by me. I fully agree to indemnify Aseana Caregivers Pte Ltd in the event of any improper, negligent practice, misconduct or misuse by me.
I acknowledge that I have read and agreed to the terms of services of Aseana Caregivers Pte Ltd.
Name
Signature
*
Date (DD/MM/YYYY)
*
/
Day
/
Month
Year
Date
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