KENILWORTH

WELCOME. Please make sure to capture all your details carefully and ensure you understand the T & Cs.

Please note that this is a 2 part registration process – ensure that you have filled out both parts.

By registering, you electronically accept and sign your registration and in turn your contract and Declarations with AP.

Please note : You will need to attach the following compliance documents so please ensure you have them on hand in electronic format to attached :
• Your CV (MS Word or PDF)
• SANC Registration (ensure paid up) – 1MB size restriction
• SANC Receipt – 1MB size restriction
• ID Book (certified) – 1MB size restriction
• Certificates (combine in ONE file if you want to submit multiple certificates) 1MB size restriction
• Bank Statement / Bank Letter – 1MB size restriction
• Proof of Indemnity Cover – 1MB size restriction
• Hepatitis B Inoculation Certificate
• Department of Health Letter on Remunerative Work Outside the Public Service (RWOPS) (if applicable)

PERSONAL DETAILS

First Name *

Surname *

Home Language *

Date of Birth *

ID/Passport *

Citizenship Status (non-SA)

Passport Country of Issue (if not South Africa)

Work Permit Expiry Date

Marital Status *

CONTACT DETAILS

Address *

Mobile Phone *

Telephone No. (alternative)

Email *

DEMOGRAPHIC DETAILS

Gender *

Race *

Disabled

Nature of Disability

TRANSPORT DETAILS

Do you have your own transport?

Drivers Licence Code

Drivers Licence Expiry Date

PDP Code

CLINICAL EXPERIENCE

Select your
Health Care Profession *

Select where you are able to work according to your scope of practice and work experience *

Certifications (for Nurses only) *

LAST COMPLETED QUALIFICATION

Qualification *

Institution *

Dates

OTHER EDUCATION / TRAINING DETAILS

Qualification 2

Institution2

Dates