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info@ritinacaregiversinternational.com
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IELTS EXAM
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REGISTER AS CAREGIVER
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?
*
Please select
Select value
Single
Married
Divorced/Seperated
Widowed
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?
Please select
English
French
Arabic
Twi
Other
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
*
Please let us know if you have experience in the following areas (tick all boxes where you have at least some experience):
Bed sores
Cancer
Dementia / Alzheimer's
Diabetes patients (including administering insulin)
General wound care
Geriatric
New-born babies (healthy)
New-born babies (with medical problems)
NGT (nasogastric tube feeding)
Paediatric
PEG (percutaneous endoscopic gastrostomy feeding tube)
Psychiatric/Special needs patients
Stoma care
Stroke patients
Suctioning of airTracheostomy careways
Urinary catheter
Simple cases only
Chemotherapy
Dialysis
Respiratory Therapy
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)
Do you have or were you ever diagnosed with any of the following conditions? Please check the corresponding boxes.
Mental illness
Epilepsy
Asthma
Diabetes
Hypertension
Tuberculosis
Heart disease
Malaria
Operations
Physical disabilities
Sexually transmitted diseases
Other conditions (ex.: thyroid conditions, migraine, chronic pain, any condition that requires regular medication => please specify in the next question)
None of the above mentioned
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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