Registration Form – Ritina Care Givers International

Name

First

Last

Email address*

Phone*

Upload Resume

Please give us your Skype ID if you have one already

Gender

Male

Female

Date of Birth*

Place of Birth*

What is your country of citizenship?*

What is your current residential address?**

What is your height in centimeters. Please just enter numerical value, eg: 168*

What is your weight in kg? Please just enter numerical value, e.g.: 57*

What is your marital status?*

Do you have children and how many? If you have children, please list their names & ages*

How many siblings do you have? (example: 1 brother and 2 sisters)*

Which languages do you speak?

What is your religion?*

Christian

Muslim

Traditionalist

Other

Do you follow a specific diet (ex. No restriction, Vegetarian, )?*

Are you currently holding a passport?**

Yes

No

If Yes,

Passport no. ………………..Date of Issue:………………Date of Expiry…………………………Place of Issue:……………………..

Which Nursing or social work School did you go to? (Name of school and city)**

Year of Graduation**

Number of years of studies?

What Nursing or Social Work degree / Diploma did you obtain?*

Caregiver Certificate

Nurse Assistant Diploma

Nurse Diploma

Bacherlor of Sciences in Nursing or higher

How many years of experience do you have as a nurse? (please enter a number only). for 10 years of experience enter 10, for 6 months of experience enter 0.5*

Are you certified for CPR / First Aid?

Yes

No

Have you worked as a Caregiver before?, if yes, give details (where, when, etc. Each experience should be written in the beginning of '*' as below)

Have you worked in Ghana r abroad before?*

Yes

No

If you worked in Ghana before, kindly provide us more details on when, position, work permit or pass that was used and your work permit number.

Current employer / city*

Current role / job

For how long have you been in this job? (please enter a number only). for 10 years of experience enter 10, for 6 months of experience enter 0.5

What is your main motivation to become a Caregiver in Ghana or abroad ?*

For how long would you like to work as a Caregiver in Ghana*

If you have any allergies, please state which one(s)

If you checked any of the boxes, please provide some information about the treatment/ medication you use(d).

What are your hobbies (what do you like to do when you are not working)?

Please give us the best Days / Times to schedule an interview with you (eg: "Tuesdays and Wednesday mornings")*

HAVE YOU OBTAINED ANY CAREGIVING, HEALTHCARE, AND SOCIAL WORK CERTIFICATION?

Yes

No

If Yes, from which Institution?

If you were referred by a friend, please let us know his / her name and email address

Please upload your degrees and certificates here*

Please upload your degrees and certificates here - upload here only if you have more than 1 degree / certificate

Please upload your degrees and certificates here - upload here only if you have more than 2 degree / certificate

Please kindly attach a nice, smiling picture of you, so we know who we are talking to when we call you

Other relevant file upload (1)

Other relevant file upload (2)

Other relevant file upload (3)

Other relevant file upload (4)

If you are experiencing difficulties in attaching your files to your application now, please send them separately by email info@ritinacaregiversinternational.com We will only process your application once you have submitted this form and all your files.

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REGISTER AS CAREGIVER