1. Application Form Please complete the application form below: What is your name and Surname?(required) What is your Maiden Name? What is your ID Number? What is your E-mail Address?(required) What is your home address? What is your postal address? EACH CANDIDATE MUST BE AVAILABLE ON HIS/HER CELLPHONE AT ALL TIMES!! What is your cell phone number?(required) Alternative number?(required) What is your School Qualification? Grade 12 Certificate from what school? What is your church name? Home Language? Afrikaans?Can SpeakCan WriteCan Read English?Can SpeakCan WriteCan Read Marital Status? Please choose ...MarriedSingleDivorcedWidowedWidower No of dependants and Ages? Health: Do you have any of the following conditions? Hypotension? YesNo Low Blood Sugar? YesNo Diabetes? YesNo Epilepsy? YesNo Migraine? YesNo Lung Sickness? YesNo Back Problems? YesNo Teeth: Please answer? Own teeth? YesNo Front teeth out? YesNo False teeth? YesNo Pregnancy: Please answer? Are you pregnant? YesNo Do you use any prevention? YesNo Do you use any medication? YesNo Write in your own words why you want to become a care worker? Agreement - I, signed and confirm that I have read and understood and agree that I will adhere to the rules’ – Must change to ‘Herewith I confirm that I have read and understood and agree that I will adhere to the rules.