Executive Staff Form:



Client Name:
Client Email:
Contact Contact Number:
Client Address:
Are you aware that there is a placement fee payable for the service?
(Yes) - (No)

Yes No
Type of Employee Sought:
(RN-Nurse, Care-Giver, etc)
Working Arrangement:
( Days/full month)
Sleep-in/Out?: Sleep In Sleep Out
If days, Rate/day
If days, which days?
Night Shift? please elaborate
Other Shift Arrangement?
Preferred Nationality:
Preferred Language:
Preferred Age:
Skills:
Oxygenation/Ventilator :
(Yes) - (No)
Yes No
Medication:
(Yes) - (No)
Yes No
Injection:
(Yes) - (No)
Yes No
Nebuliser:
(Yes) - (No)
Yes No
Registered Nurse/Care-Giver?
Child/Adult? please specify everthing
Other: anything else you want to add

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Contact Info:

Contact Numbers:
(011) 234 3249
(011) 234 1863
(011) 234 5623
079 537 1248

Email: info@nannymaids.co.za

Address:
Sunninghill Village Centre
Maxwell Drive (Upper Level)


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