Nursing and Care Worker Screening Form


Nursing and Care Worker Screening Form

Thank you for your interest in registering with MHR. Kindly complete the following screening form in full, providing us with all the required details. The fields marked with a * are mandatory fields. Please note that the information supplied on this form will be regarded as strictly confidential and will only be used for recruitment and selection purposes.


 
 

Personal Information

(e.g 0821231234)




Type N/A if non-South African citizen


 
 

Type N/A if you are a care worker

 
 

Education and Training



Year highest qualification was completed


Year training was completed
Area, Hospital/Facility and Ward/Unit of Preference



Employment Information (Excluding Practical Training)
NB: This section focuses on your work experience. Please do not include practical experience gained during your studies.

 
 
References
Please provide two professional contactable references not older than five years (Preferably no cell phone numbers)

 
 

As MHR prefers two professional references, state a reason for one reference

First Reference







NB: Only list a cell phone number if no landline no. is available (e.g. 0821231234)

NB: Please only select lecturer if you are a newly qualified student and consulted the lecturer in advance for a reference.

Second Reference







NB: Only list a cell phone number if no landline no. is available (e.g. 0821231234)

NB: Please only select lecturer if you are a newly qualified student and consulted the lecturer in advance for a reference.

If you need help with this form, please contact a representative who will gladly assist you.