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New Employment Contract
Join Immploy Medical Recruitment by completing the application form below.
Please enable JavaScript in your browser to complete this form.
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Step
1
of 11
Documents
*
I hereby confirm I have all the required documents to complete registration.
Certified documentation required
-Identity Document/Valid Passport/Valid Visa/Right to work permit [RWOP]/Refugee ID/Card
-Qualification: Grade 12/Diplomas/Degrees
-Marriage or name change certificate (if applicable)
Medical qualified candidates
-Valid SANC/SAPC/HPSCA/SACSSP registration certificate and receipt for payment and card
-Nursing: Proof of Hepatitis B Vaccination
-Dispensing Licence (if applicable)
-Professional Indemnity Insurance (if applicable)
The above is only required for qualified medical candidates but kindly attach any experience related qualifications to add to your profile.
Other Documents required
-CV in Word format [2 contactable referees]
-Proof of tax number (a letter from SARS or IRP5 will be accepted)
-Proof of bank account (original bank statement, letter from bank/all not older than 3 months)
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Personal Details
Your information which allows us to contact you.
Title
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First Name
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Last Name
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Date of Birth
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1920
Nationality
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ID/Passport Number
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Gender
*
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Male
Female
Other
Marital Status
*
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Single
Married
Divorced
Widowed
Employment Equity
*
-
Black
Coloured
Indian
White
Other
Visa Type
*
Not Applicable
Work Visa
Business Visa
Home Language
*
Second Language
*
Other Languages
Home Telephone
Cell Number
*
Secondary Cell Number
Email
*
Home Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
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Emergency Details
In an emergency, we'll use the details below.
First Name
*
Last Name
*
Relationship
*
Contact Number
*
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Professional References
This is a log of your previous work experience, only two are required.
Position One Held
*
Start Date
*
End Date
*
Institution
*
Contact Person and Position
*
Contact Number
*
Position Two Held
*
Start Date
*
End Date
*
Institution
*
Contact Person and Position
*
Contact Number
*
Other Position Held
Start Date
End Date
Institution
Contact Person and Position
Contact Number
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Banking and Tax Details
This is so that our finance department can pay you straight into your account.
Account Holder Name
*
Bank
*
Account Number
*
SARS Tax Registration Complete - Yes/No?
*
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Yes
No
Tax Registration Number
*
Only working through Immploy - Yes/No?
*
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Yes
No
PAYE: What Tax Percentage (%) should be deducted?
*
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Tax Table
25%
30%
35%
41%
I have a current Tax Directive and I have provided this document to Immploy - Yes/No
*
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Yes
No
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Security Check
As employers, we need this information.
Do you have a criminal record?
*
If yes, specify.
Are you listed on the ITC?
*
If yes, specify,
Please attach the relevant documents listed below:
• Clear Photo for Name Badge
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant documents listed below:
• Identity Document/Passport
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant documents listed below:
• Visa and Passport (Where applicable)
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant documents listed below:
• Curriculum Vitae (Word or PDF format)
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Proof of Registration with Regulatory Body
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Proof of Tax Number
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Statement of Academic Record/Transcript
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Proof of Bank Account (Stamped)
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Marriage Certificate/Name Change Documents
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Valid SANC/SAPC/HPSCA/SACSSP registration certificate and receipt for payment and card (kindly attach the applicable documents)
Upload and attach your document here:
Click or drag files to this area to upload.
You can upload up to 4 files.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Nursing: Proof of Hepatitis B Vaccination
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Dispensing Licence (if applicable)
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
Please attach the relevant document listed below:
• Professional Indemnity Insurance (if applicable)
Upload and attach your document here:
Click or drag a file to this area to upload.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
I confirm that I am aware of the annual leave options, and select:
*
-
Option One (All Inclusive)
Option Two (Accrual)
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Skills Matrix
Tick only five (5)
job roles that you've been exposed to in the
last two (2) years.
Please select the division under which you fall:
*
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Nursing
Doctors/Radiology
Pharmacy
Healthcare Professionals - Specialist
Healthcare Professionals - Other
Healthcare Professionals - Social Workers
Dentistry
Please be sure to choose the correct division.
Nursing Skills
*
Casualty Trained
Community Clinics
PHC
Casualty Experience
Dispensing Licence
CNP Trained
Fertility Clinic
Termination Clinic
CNP Experienced
VCT Trained
PMTCT
Occupational Health Trained
VCT Experienced
Occupational Health Experience
Home Care
Rehabilitation Centre
Stoma Care
General
Day Surgery
Surgical - General
Medical
ICU Experienced
In Charge Duties
Prisons
ICU Trained
NICU
High Dependency Unit
ICU Psychiatric
PICU
Vent Competent
NIMART Trained
Dispensing Certificate
IMCI Trained
BANC Trained
Nursing Skills (copy)
*
Dentist
Dental Therapist
Dental Assistant
Dental Technician
Oral Hygienist
Dentist Tertiary Level care
Doctors/Radiology Skills
*
MO Casualty - Casualty ACLS
MO Casualty - Casualty ATLS
MO Casualty - Casualty BLS
MO Casualty - FMA
MO Casualty - Casualty PALS
MO Casualty Casualty- Emergency Medicine
MO General - GPMO General - General Medicine
MO General - GP Dispensing License
MO Primary - Family Planning
MO Primary - Termination of Pregnancy
MO Primary - OPDMO Primary - Internal Medicine
MO Primary - HIVMO Primary - TB
MO Paediatrics - Paediatrics
MO Paediatrics - Paediatrics General
MO Paediatrics - Paediatrics Surgery
MO Specialised - Anaesthetics
MO Specialised - ARV
MO Specialised - Audiology
MO Specialised - Aviation Medicine
MO Specialised - Biochemistry
MO Specialised - Cardiology Adult
MO Specialised - Cardiothoracic Surgery
MO Specialised - Dermatology Gastro
MO Specialised - Dermatology Geriatric
MO Casualty - Casualty ALS
MO Other - Forensic Medical Officer
MO Other - Disability Grant
Emergency Medicine - Gastroenterology
Emergency Medicine - ENT Surgery
Emergency Medicine - Genito-urinary Medicine
Emergency Medicine - Geriatrics
Emergency Medicine - Good Clinical Practice
Emergency Medicine - Histology
Emergency Medicine - ICU
Emergency Medicine - Marine Medicine (Sports & Professional Driving)
Emergency Medicine - Medical Scientists
Emergency Medicine - Military
Emergency Medicine - Mountain Medicine
Emergency Medicine - Neonatal
Emergency Medicine - Nephrology
Emergency Medicine - Neurosurgery
Emergency Medicine - Obs & Gynae
Emergency Medicine - Occupational Health
Emergency Medicine - Oncology Ophthalmology
Emergency Medicine - Oral Surgery
Emergency Medicine - OrthopaedicsEmergency Medicine - Pathology
Emergency Medicine - Plastic Surgery
Emergency Medicine - Rheumatology
Emergency Medicine - Surgery
Emergency Medicine - TB
Emergency Medicine - Urology
Radiology - Radiologist
Radiology - Radiographer
Radiology - Nuclear Radiology
Radiology - Therapy
Radiology - Ultrasound
Radiology - Radiology
Radiology - Assistant Sonographer
Pharmacy Skills
*
Pharmacy Clinical - Clinical Pharmacist
Pharmacy Clinical - Clinical Pharmacist Assistant Basic
Pharmacy Clinical - Clinical Pharmacist Assistant Post Basic
Pharmacy Distribution - Distribution Pharmacist
Pharmacy Distribution - Distribution Pharmacist Assistant Basic
Pharmacy Distribution - Distribution Pharmacist Assistant Post Basic
Pharmacy Production - Production Pharmacist
Pharmacy Production - Production Pharmacist Assistant Basic
Pharmacy Production - Production Pharmacist Assistant Post Basic
Pharmacy Quality Assurance - QA Pharmacist
Pharmacy Quality Assurance - QA Pharmacist Assistant Basic
Pharmacy Quality Assurance - QA Pharmacist Assistant Post Basic
Pharmacy Hospital Private - Hospital Pharmacist
Pharmacy Hospital Private - Hospital Pharmacist Assistant Basic
Pharmacy Hospital Private - Hospital Pharmacist Assistant Post Basic
Pharmacy Hospital Government/CHC - Hospital Pharmacist
Pharmacy Hospital Government/CHC - Hospital Pharmacist Assistant Basic
Pharmacy Hospital Government/CHC - Hospital Pharmacist Assistant Post Basic
Pharmacy Retail - Pharmacist
Pharmacy Retail - Pharmacist Assistant Basic
Pharmacy Retail - Pharmacist Assistant Post Basic
Healtcare Professional Skills
*
Dieticians
Occupational Therapist
Clinical Psychologist
Speech Therapist
Audiologist
Physiotherapist
SHEQ Psychiatrist
Psychiatrist
Optometrists
Biokineticist
Reflexologist
Biochemist
Nutritionist
Medical technologist
Chiropractor
Orthopaedic technician
Optical dispenser
Psychometrist
Environmental Health Practitioner
Orthotist
Healtcare Professional Skills (copy)
*
Adolescents
Adult
Children
Child Protection Worker
Clinical Psychologists
Counsellor
Drug/Alcohol Abuse
Educational Social Worker
Elderly Family Centre Worker
Fostering/Adoption Worker
Generic/Duty Field Worker
HIV
Homeless
IT Juvenile Justice Worker
Learning Disability
Mental Health
Physically Disabled
Probation Services
Residential
Senior Manager
Sensory Impairment
Social Work Trainer
Speech Therapists/Audiologists
Unqualified Social Worker
Healtcare Professional Skills (copy)
*
Administration Assistant
CSSD
Porter
Ward Clerk
Cleaner
Medical Receptionist
General Worker
Skilled Worker
Code 8 Driver
Code 10 Driver
Code 14 Driver
Forklift Driver
Paramedic – ALS
ECP
ILS
BLS
ECT
EMS medical commander
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If you were referred to Immploy by a friend, please enter their details below (Optional)
Terms and Conditions
Organised by Immploy Medical Recruitment Agency CC (“Immploy” also referred to as the “Promoter”).
To win, participants refer a friend to Immploy Medical Recruitment. Upon the referee’s successful registration and completion of 160 hours of work, the referrer will receive a cash incentive in accordance with our tiered system.
Each successfully registered referral, who completes 160 hours of work will result in the referrer receiving a cash incentive.
Your entry into the competition and/or your acceptance of the cash prizes constitutes your binding acceptance, agreement, and understanding of its terms and conditions.
Incentivised cash prizes will comply with the following tiered system:
ENA (Enrolled Nursing Auxiliaries) R750
EN (Enrolled Nurses) R1 000
RN (Registered Nurses) R1 500
SRN (Specialised Registered Nurses, including ICU nurses, Midwives, and Psychiatric Nurses) R2 000
NOTE: Referees must be successfully registered with Immploy Medical Recruitment and have completed 160 hours of work before the referrer receives their prize.
Competition entrants
Only Nurses registered with Immploy may refer a friend.
Only new Nurses who refer a friend, whose referral successfully registers and completes 160 hours of work will be eligible to receive a cash incentivised prize.
The Competition is not open to:
Any employee other than Nurses currently registered with Immploy Medical Recruitment.
New Sign-Ups.
General
If required by the consumer protection commission or for any other reason, the promoters shall have the right to terminate this promotional competition with immediate effect and without notice of such termination. In such event, all entrants hereby waive any rights they may have against the promoter and hereby acknowledge that they will have no recourse or claim of any nature whatsoever against the promoter, their directors, members, partners, employees, sponsors, agents, or consultants.
These terms and conditions will be construed, interpreted, and enforced under the laws of contract and dispute resolution in the Republic of South Africa. Immploy and the judges’ decision on any matter concerning the Competition and/or arising out of these terms and conditions is final and binding on you, and no correspondence will be entered.
Should any dispute arise concerning the interpretation of these Competition Rules, Immploy’s decision shall be final, and no correspondence shall be entered into.
All queries relating to these incentive structures should be directed to the attention of:
[email protected]
For more information or clarity on the above, please call 087 077 0888.
Name & Surname
First
Last
ID number
Mobile Number
Email address
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Accept all Terms & Conditions
Privacy Policy
*
I hereby accept the
Consent to Processing Personal Information
Immploy Recruitment Agency CC
EMPLOYEE, JOB APPLICANTS, DIRECTORS CONSENT FORM THE PROTECTION OF PERSONAL INFORMATION ACT 4 OF 2013
1. INTRODUCTION
1.1. Immploy Recruitment Agency CC, as a commercial entity and in our capacity as a Responsible Party, in order to engage with you, will have to process your Personal Information, and in doing so, will have to comply with the Protection of Personal Information Act, 2013 (“POPIA”).
2. APPLICATION
2.1. This Consent Form applies to the following persons:
2.1.1. Applicants: persons who wish to apply for a vacant position, employment opportunity or a sponsorship from us.
2.1.2. Employees and Directors: Persons who are employed by us or who have been appointed as directors.
3. PURPOSE FOR PROCESSING YOUR PERSONAL INFORMATION
3.1. Your personal information will be processed by us for the following purposes: 3.1.1. Employment: To conduct and communicate with you regarding recruiting and human resource administration, to manage recruitment including legal eligibility for work and vetting;
3.1.2. Employment: To conclude an employment contract with you, to manage hires, promotion and succession planning; and to conduct and communicate with you regarding your employment and to perform human resources administration, financial administration, comply with labour, Tax and B-BEEE laws, management and organizational administration, training, and skills development, including performance assessments and disciplinary matters;
3.1.3. Due diligence purposes: To carry out ongoing due diligence exercises including obtaining and verifying your details and / or credentials, such as receiving and verifying your identity, education, qualifications and employment history, medical and health history and related records, financial, credit and tax status and history, and or any employee performance related history;
3.1.4. Employment benefits: To manage your benefits, including administering remuneration, relocation, insurance, payroll, pensions and other employee benefits and tax, including disclosure to other affiliates within the Group and to others such as payroll providers, accountants, occupational health providers, insurers, pensions administrators, hosting service providers and legal advisers;
3.1.5. Operational issues: To communicate, enforce and ensure you comply with policies, including in relation to claims, disciplinary actions or legal requirements and conducting investigations and incident response, including reviewing your communications in these situations in accordance with relevant internal policies and applicable law;
3.1.6. Occupational health: To manage occupational health and absence and fitness for work and notifying family members in emergencies;
3.1.7. Travel: To facilitate business travel, travel-related support including conference attendance, bookings, and emergency support service;
3.1.8. Employment Equity: To monitor equal employment opportunities, in respect of diversity categories including but not limited to age, gender, ethnicity, nationality, religion, disability, sexual orientation, and marital or family status;
3.1.9. IR and Labour relations: To manage membership to trade unions and collective agreements for administering collective employee arrangements where these are in place;
3.1.10. Communications: To make contact with you and to communicate with you generally or in respect of our requirements, or instructions, or to respond to you in order to comply with your specified or general instructions;
3.1.11. Risk assessment and anti- bribery and corruption matters: For internal and external auditing, assurance and risk management purposes;
3.1.12. Legal obligation and public duties: To comply with the law and our legal obligations, including to register with Regulators, obtain and hold permits and certificates, register for VAT, Tax, PAYE, SDL, COIDA and UIF etc., to submit reports or provide various notices or returns, to litigate and / or to respond to a request or order from a SAP official, investigator or court official, regulator, or public authority;
3.1.13. Security purposes - legitimate purpose and to comply with laws: To permit you access to our offices, facilities, operations or parking areas, as well as to controlled areas, for the purposes of monitoring via CCTV, your interaction and access in and from our facilities described above, and for general risk management, security and emergency incident control purposes as well as for providing IT access and support and for employee authentication and for data and cybersecurity purposes;
3.1.14. For internal research and development purposes: For statistical analysis and research purposes in the context of employment;
3.1.15. Effectuate the sale, merger, acquisition, or other disposition of our business (including in connection with any bankruptcy or similar proceedings)
3.1.16. Legitimate interest: to comply with our legal obligations and to change our business structure we may disclose your Personal Information in connection with proceedings or investigations anywhere in the world to third parties, such as public authorities, law enforcement agencies, regulators and third-party litigants. We may also provide relevant parts of your Personal Information to any potential acquirer of or investor in any part of the Group’s business for the purpose of that acquisition or investment.
4. DETAILS OF THE PERSONAL DATA OR INFORMATION WE COLLECT FROM YOU
4.1. In order to engage and / or interact with you, for the purposes described above, we will have to process certain types of your Personal Information, as described below:
4.1.1. Your contact information, such as name, alias, address, identity number, passport number, security number, phone number, cell phone number, vehicle make and registration number, social media user ID, email address, and similar contact data, serial numbers of equipment, details regards the possession of dangerous weapons, and other contact information including details of your previous employers, memberships or affiliations, including professional bodies and trade unions, and similar data, which are required for various legitimate interest, contractual and / or lawful reasons pertaining to your application for employment or actual employment with the Organisation.
4.1.2. Career, Education, and Employment Related Information, such as job preferences or interests, work performance and history, salary history, nationality and immigration status, demographic data, professional licensure information and related compliance activities, accreditations and other accolades, education history (including schools attended, academic degrees or areas of study, academic performance, and rankings), and similar data, which are required for contractual or employment related matters or which are required to comply with laws and public duties.
4.1.3. Special Personal Information, which are required in order to protect legitimate interests, comply with legal obligations or public legal duties, or in order to accommodate you in our workplaces, such as your race, disability-related information (Employment Equity related), religion (correct and fair treatment related), sexual and medical history including any medical conditions (to comply with laws and related to correct and fair treatment issues), trade union matters (to comply with laws and related to correct and fair treatment issues), and financial, credit, deviant and criminal history, (to protect our legitimate interests and to perform risk assessments), as well as children’s details (benefits related) and Biometrics such as finger prints, which are required in order to provide you with access to our facilities, give you access to our IT infrastructure, for security monitoring purposes and in order to comply with health and safety requirements in the workplace.
4.1.4. Demographic Information, such as country, preferred language, age and date of birth, marriage status, gender, physical characteristics, personal or household / familial financial status and metrics, and similar data, which are required for various legitimate interests, as well as contractual and / or lawful reasons pertaining to your actual employment with the Organisation.
4.1.5. Your Image, still pictures, video, voice, and other similar data, which are required in order to provide you with access to our facilities, give you access to our IT infrastructure, for security monitoring purposes as well for other lawful reasons pertaining to your employment with the Organisation.
4.1.6. Public issued Identity Information, such as government-issued identification information, tax identifiers, social security numbers, other government-issued identifiers, and similar data, which are required to comply with laws and public duties as well for other lawful reasons pertaining to your employment with the Organisation.
4.1.7. Tax and Financial Information, banking details, and tax registration number and status, which are required to perform contractual matters and / to comply with tax laws and public duties.
4.1.8. IT Information, including IT security-related information (including IT user names and passwords, authentication methods, and roles), and similar data, which are required for various legitimate interests, contractual and / or lawful reasons pertaining to your actual employment with the Organisation.
4.1.9. Health history and records, which is classified as Special Personal Information, such as medical status and history, examinations, blood type, medical aid history, disabilityrelated information, biometrics, medicals, psychometrics and similar data, which are required for contractual or employment related matters or which are required to comply with laws and public duties.
4.1.10. Social Media and Online activities and presence, such as information placed or posted in social media and online profiles, online posts, and similar data, which are required for contractual or employment related matters or which are required to comply with laws and public duties.
5. SOURCES OF INFORMATION - HOW AND WHERE WE COLLECT YOUR PERSONAL INFORMATION FROM YOU
5.1. Depending on your requirements, we will collect and obtain Personal Information about you either directly from you, from certain third parties or from other sources which are described below: 5.1.1. Direct collection: You provide Personal Information to us when you:
5.1.1.1. interact with us;
5.1.1.2. enquire about, or apply for a position within our Organisation, including requesting or signing up for information;
5.1.1.3. express an interest in working with us or apply for a job or position or bursary, learnership or sponsorship with us;
5.1.1.4. take up a job or position with us;
5.1.1.5. conclude a contract with us;
5.1.1.6. communicate with us by phone, email, chat, in person, or otherwise;
5.1.1.7. complete a questionnaire, or other information request form.
5.1.2. Automatic collection: We collect Personal Information automatically from you when you:
5.1.2.1. search for, visit, interact with, or use our websites, applications, mobile applications, or social media portals or platforms; 5.1.2.2. access, use, or download content from us;
5.1.2.3. open emails or click on links in emails or advertisements from us;
5.1.2.4. Otherwise interact or communicate with us.
5.1.3. Collection from third parties: We collect Personal Information about you from third parties, such as:
5.1.3.1. recruitment or employment agencies, previous employees and colleagues;
5.1.3.2. your previous employer;
5.1.3.3. regulators, professional or industry organisations and certification / licensure agencies that provide or publish Personal Information related to you;
5.1.3.4. third parties and affiliates who deal with or interact with us or you;
5.1.3.5. service providers and business partners who work with us and that we may utilize to deliver services; 5.1.3.6. SAP, Home Affairs, Credit bureaus and other similar agencies;
5.1.3.7. Government agencies, regulators and others who release or publish public records;
5.1.3.8. Other publicly or generally available sources, such as social media sites, public and online websites, open databases, and data in the public domain.
6. HOW WE SHARE YOUR INFORMATION
6.1. We share Personal Information with the following categories of recipients:
6.1.1. Our employees, the Group and our affiliates for employment, HR, IR, business and operational purposes.
6.1.2. Your Contacts and other employees in order to fulfil or perform a contract or other legal obligation, including with third parties that arrange or provide you with goods or services and who we pay in connection with such access. We may also share your Personal Information with other employees in the Organisation.
6.1.3. Business Partners and Third-Party Service Providers, as well as Operators to perform tasks on our behalf and which are related to our relationship with you, including financial, benefits, health and medical, and wellness benefits etc. and to assist us in offering, providing, delivering, analysing, administering, improving, and personalising such services or products.
6.1.4. Third Party Content Providers. We may share your Personal Information with our third-party content providers to perform tasks on our behalf and to assist us in providing, delivering, analysing, administering, improving, and personalising content related to our relationship with you, including financial, benefits, health and medical, and wellness benefits etc. and may to this end pass certain requests from you to these providers.
6.1.5. Cyber Third-Party Service Providers. We may share your Personal Information with our third-party cyber service providers to perform tasks on our behalf and which are related to our relationship with you, including those who provide technical and/or customer support on our behalf, who provide application or software development and quality assurance, who provide tracking and reporting functions, research on user demographics, interests, and behaviour, and other products or services. These thirdparty service providers may also collect Personal Information about or from you in performing their services and/or functions. We may also pass certain requests from you to these third-party service providers.
6.1.6. Advertisers. We may share your Personal Information with advertisers, advertising exchanges, and marketing agencies that we engage for advertising services, to deliver advertising, and to assist us in advertising our brand and products and services.
6.1.7. Users. We aggregate information from public records, phone books, social networks, marketing surveys, business websites, and other sources made available to us to create listings and profiles that are placed into user listings and directories. Additionally, if you choose to include your Personal Information in any reviews, comments, or other posts that you create, then that Personal Information may be displayed other users as part of your posting.
6.1.8. Regulators and law enforcement agencies. We may disclose your Personal Information to regulators and other bodies in order to comply with any applicable law or regulation, to comply with or respond to a legal process or law enforcement or governmental request.
6.1.9. Other Disclosures. We may disclose your Personal Information to third parties if we reasonably believe that disclosure of such information is helpful or reasonably necessary to enforce our terms and conditions or other rights (including investigations of potential violations of our rights), to detect, prevent, or address fraud or security issues, or to protect against harm to the rights, property, or safety of the group, our employees, any users, or the public.
6.1.10. In the Event of Merger, Sale, or Change of Control. We may transfer this Processing Notice and your Personal Information to a third-party entity that acquires or is merged with us as part of a merger, acquisition, sale, or other change of control (such as the result of a bankruptcy proceeding).
7. HOW WE SECURE YOUR INFORMATION
7.1. The security of your Personal Information is important to us. Taking into account the nature, scope, context, and purposes of processing personal information, as well as the risks to individuals of varying likelihood and severity, we have implemented technical and organizational measures designed to protect the security of personal information. In this regard we will conduct regular audits regarding the safety and the security of your Personal Information.
7.2. Your Personal Information will be stored electronically which information, for operational reasons, will be accessible to persons employed or contracted by us on a need-to-know basis, save that where appropriate, some of your Personal Information may be retained in hard copy.
7.3. Once your Personal Information is no longer required due to the fact that the purpose for which the Personal Information was held has come to an end, such Personal Information will be retained in accordance with our records retention policy, which varies depending on the type of processing, the purpose for such processing, the business function, record classes, and record types. We calculate retention periods based upon and reserve the right to retain Personal Information for the periods that the Personal Information is needed to: (a) fulfil the purposes described in this consent form, (b) meet the timelines determined or recommended by regulators, professional bodies, or associations, (c) comply with applicable laws, legal holds, and other legal obligations (including contractual obligations), and (d) comply with your requests.
8. ACCESS BY OTHERS AND CROSS BORDER TRANSFER
8.1. We may from time to time have to disclose your Personal Information to other parties, including our holding company or subsidiaries, trading partners, agents, auditors, organs of state, regulatory bodies and / or national governmental, provincial, or local government municipal officials, or overseas trading parties or agents, but such disclosure will always be subject to an agreement which will be concluded as between ourselves and the party to whom we are disclosing your Personal Information to, which contractually obliges the recipient of your Personal Information to comply with strict confidentiality and data security conditions.
8.2. Where Personal Information and related data is transferred to a country which is situated outside South Africa, your Personal Information will only be transferred to those countries which have similar data privacy laws in place or where the recipient of the Personal Information concludes an agreement which contractually obliges the recipient to comply with strict confidentiality and data security conditions and which in particular will be to a no lesser set of standards than those imposed by POPIA.
9. YOUR RIGHTS
9.1. You as a Data Subject you have certain rights, which are detailed below:
9.1.1. The right of access - You may ask us free of charge to confirm that we hold your personal information, or ask us to provide you with details, at a fee, how we have processed your personal information, which can be done by following the process set out under our PAIA Manual which can be accessed on our website or obtained from the Information Officer.
9.1.2. The right to rectification - you have the right to ask us to update or rectify any inaccurate personal information, which can be done by requesting the update / rectification request Form from the Information Officer.
9.1.3. The right to erasure - where any overriding legal basis or legitimate reason to process your Personal Information no longer exists, and the legal retention period has expired, you may request that we delete the personal information, which can be done by accessing the request for erasure Form which from the Information Officer.
9.1.4. The right to object to and restrict further processing - where we do not need your consent to process your personal information, but you are not in agreement with such processing, you object to us processing such Personal Information which can be done by requesting the objection request Form from the Information Officer.
9.1.5. The right to withdraw consent - where you have provided us with consent to process your personal information, you have to right to subsequently withdraw your consent, which can be done by requesting the withdrawal of consent request Form from the Information Officer.
9.1.6. The right to data portability - where you want your Personal Information to be transferred to another party, which can be done under certain circumstances, please contact the Information Officer.
10. INFORMATION OFFICER
The Company Information Officer details are:
Unit F6, Bayside Office Park, 41 – 43 Erica Road, Table View, 7441
021 – 556 3990
[email protected]
11. PROCESSING PERSONAL INFORMATION
11.1.If you process another’s Personal Information, you will keep such information confidential and will not, unless authorised to do so, process, publish, make accessible, or use in any other way such Personal Information unless in the course and scope of your duties, and only for the purpose for which the information has been received and related to the duties assigned to you.
11.2.You will also observe our POPIA policies which sets out the rules and regulations regarding the processing and protection of Personal Information (including Special Personal Information) and/or data to which the Employee has access in the course and scope of the Employee's duties, and shall report any infringement relating to the manner in which Personal Information or other data is processed to the Company without delay.
12. CONSEQUENCES OF YOU WITHHOLDING CONSENT OR PERSONAL INFORMATION
12.1.Should you refuse to provide the Company with your Personal Information, which information is required by the Company for the purposes indicated above, together with the required and requisite consent to process the aforementioned Personal Information, then the Company will be unable to engage with you and/or enter into any subsequent relationship with you.
13. COMPLAINTS
13.1.Should you wish to discuss a complaint, please feel free to contact us using the details provided above.
13.2.Should you feel unsatisfied with our handling of your Personal Information, or about any complaint that you have made to us, you are entitled to escalate your complaint to the South African, Information Regulator who can be contacted at .
14. ACCEPTANCE
14.1.By providing us with the Personal Information which we require from you as listed under this Consent Form:
14.1.1. You acknowledge that you understand why your Personal Information needs to be processed;
14.1.2. You accept the terms which will apply to such processing, further processing, including the terms applicable to the transfer of such Personal Information cross border;
14.2.You consent to providing the Personal Information required, to the Company, on the understanding that the Company is responsible to abide by the principles set out in POPIA, in the Company POPIA Policy, and in this Consent Form.
14.3.You declare that all Personal Information being supplied to the Company is accurate, up to date, not misleading, and that it is complete in all material respects.
14.4.You undertake to advise the Company immediately of any changes to your Personal Information, should any of the details change.
14.5.By providing the Company with your Personal Information, you consent and give the Company permission to process and further process the Personal Information, as and when required, that you supply to the Company, understanding the purposes for which the Personal Information is required and for which it will be use.
14.6.You accept the contents of this Consent Form as adequate notification and processing of the Personal Information and Special Personal Information by the Company and, insofar as it is necessary, consent to the Company failing to provide full notification in terms of Section 18 of POPI, which consent is permitted in terms of Section 18(4) of POPI.
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Declaration
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I hereby accept the
Declaration
and of the above-mentioned temporary contract with Immploy Medical Recruitment.
DECLARATION
The particulars of the Agency are as follows:
Name:
IMMPLOY RECRUITMENT AGENCY CC
Address:
UNIT F6 BAYSIDE OFFICE PARK, 41-43 ERICA ROAD, TABLE VIEW, 7441
Name & designation of person concluding this agreement on behalf of employer:
General Manager
1. I hereby authorise lmmploy Recruitment CC and their verification agents to forward any personal information as well as any information that I have provided in support of my application to verification information suppliers acting on behalf of lmmploy Recruitment CC or the verification agents (including but not limited to the South African Police Services, the Government of the RSA, educational, training, credit bureau, and fraud prevention organisation) for the purpose of verifying my personal credentials and records.
2. I agree that lmmploy may withhold payment of my salary until such time that they are furnished with the above-mentioned documents.
3. I declare that the above information is correct and accurate.
4. I declare that the information in my CV is correct and accurate.
5. I declare that I am eligible to work and that I have completed the necessary RWOPS forms if applicable.
6. I declare that I aware that I must disclose if my name appears in Part B of the National Child Protection Register in terms of the Children’s Act, 38 of 2005
7. I have read and agree with the terms and conditions regarding “Competitions & Promotions” that are found on Immploy.com
8. Professional Indemnity – I understand that I need to have professional indemnity cover In place at all temporary assignments and I will not undertake assignments without ensuring that this cover is in place.
9. I undertake to complete my duties and obligations to the client to which I am assigned to.
10. I understand that my assignment, conditions of service, and remuneration will be per the applicable legislation, rules, and regulations.
11. I hereby agree that lmmploy Recruitment CC will be the sole employment agency to facilitate any locum, contract, or permanent employment that may derive directly or indirectly from any positions that may stem from my application to lmmploy Recruitment CC and/or their clients.
12. I declare that I am eligible to take up employment within South Africa and I am currently registered and in good standing with the appropriate regulating body for my profession.
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Terms & Conditions
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I hereby accept the
Terms and Conditions
of the above-mentioned temporary contract with Immploy Medical Recruitment.
Terms and Conditions
The particulars of the Agency are as follows:
Name: IMMPLOY RECRUITMENT AGENCY CC
Address: UNIT F6 BAYSIDE OFFICE PARK, 41-43 ERICA ROAD, TABLE VIEW, 7441
Name & designation of person concluding this agreement on behalf of employer: General Manager
The particulars of the Employee are as follows and are used in conjunction with the information on the New Employee Form:
The Agency and Employee hereby agree to the following terms and conditions of employment:
1. SPECIFIC TERMS OF EMPLOYMENT
Duties and Remuneration
a. The remuneration payable to the Employee is set out in Assignment confirmations as and when an assignment has been confirmed by the Employee, which forms part of this Contract of Employment.
b. It is further recorded that the remuneration of the Employee may vary from time to time.
Orientation at a new client may or may not be remunerated based on the agreement with the client.
c. The Employee will be paid weekly, in arrears, following the week in which the work was performed.
The Employee’s wages will be paid directly into his/her bank account.
d. The Employee will be paid by the hour and his/her rate will be based on his/her skills and experience, and the requirements of each assignment as received from the client of the Agency.
e. Timesheets (fully completed and signed by the Employee and the Client’s representative) must be delivered, emailed, or faxed to the Agency’s office at the stipulated cut off times as will be communicated to you by the Agency, from time to time. 1.1 Normal Working Hours and Overtime
a. Working hours will vary from client to client and from assignment to assignment. The Employee will be advised of the working hours applicable to each assignment, prior to its commencement.
b. The Employee’s ordinary working hours will not exceed any statutory maximum, which may apply to any particular assignment.
c. Should a Compressed Working Week in accordance with Chapter 2, Section 11 of the Basic Conditions of Employment Act of 1997, “The Act”, be in place (or be implemented) the Employee will be required to work up to twelve (12) hours a day over a 45 hour week inclusive of meal intervals.
These hours may by agreement with the Employee and the Client, be varied or averaged within limits set by law, from time to time.
d. If there is any aspect of the assignment which concerns the Employee, he/she is obliged to discuss this with the Agency’s representative immediately.
e. The duties of the Employee in respect of each assignment will be client-specific and be communicated to the Employee on the first assignment but may change from time to time on request of the client.
1.2 Leave
a. Annual Leave
i) A provision for leave pay is included in the rate of pay and is indicated in Assignment confirmations as per 1.a above.
ii) If the accrual option is selected or specified then the Employee will not be entitled to take time off with respect to vacation leave but will be entitled to a leave pay-out, before the end of the year.
iii) The leave pay-out, payable to the Employee in terms of ii above, will be the total of the leave provision, accumulated over the period of the assignments worked.
b. Maternity Leave
i) Due to the nature of employment, Maternity Leave is not applicable.
1.3 Statutory and General deductions
a. The Agency is required to deduct from The Employee’s remuneration certain amounts prescribed by the law i.
e. deductions under the PAYE system and compulsory contributions to the Unemployment Insurance Fund.
b. IRP5 certificates will be issues yearly to all of the agency’s employees from whom employee tax has been deducted.
c. The Employee is obliged to inform the Agency if the Employee is employed by any other agency and/or is performing employment for which the Employee receives additional remuneration, as this has an impact on the year-end tax deductions.
d. The Agency will not be held responsible if any employee tax calculated by the Agency is calculated incorrectly.
e. In terms of the new regulations issued by SARS, a person is required to register as a taxpayer regardless of whether he/she will be liable for income tax or not.
f. The Employee hereby irrevocably confirms that his/her Income Tax affairs are the full responsibility of the Employee. The Agency will not be held liable for any tax responsibilities of the Employee.
1.4 Timesheets
a. The Employee’s timesheet is of paramount importance to The Employee’s weekly remuneration.
b. The Employee is obliged to confirm that the designated signatory in the Client’s office has signed the timesheet. The Employee must sign the timesheet him/herself (full signature, not initials) before handing the timesheet in with the Employee’s Supervisor. Incorrectly completed and unauthorized timesheets will result in the Employee not receiving any payment.
c. The Employee hereby confirms and takes specifically note of the fact that if incorrect information appears on the Employee’s timesheet and/or the timesheet is posted late the posting of the Employee’s timesheet will be delayed.
d. If there is any discrepancy in the timesheet to the loss of the Employee then the Employee waives his / her right to keep the Agency liable for any loss or reduction in remuneration.
1.5 Security Measures
a. The Employee agrees that he/she may from time to time be required by the Agency and/or a client to submit to appropriate security measures.
The measures include but are not limited to, searches of parcels, lockers, bags, clothing and body searches and vehicles in which the Employee is traveling.
The Employee accordingly consents to be subjected to such appropriate security measures if requested by a representative of either the Agency or the Client.
1.6 Confidentiality
a. During assignments, the Employee will have access to information that is confidential to the Agency and/or the Client.
b. All information that comes to the Employee in the course of the Employee’s work with any of our clients must be treated as strictly confidential.
c. The Employee by the signature of this agreement undertakes to keep confidential all such information which may be disclosed to The Employee during his/her assignment or to which the Employee may have access by virtue of his/her assignment unless such disclosure is authorized by the Agency or the client.
2. GENERAL MATTERS CONCERNING THE EMPLOYEE
a. If the Employee has any queries regarding rates or remuneration the Employee is obliged to contact the Agency and/or its representative and never the Client.
b. Non-compliance with paragraph (a) above will result in the Employee being disciplined by the Agency.
3. OBLIGATIONS OF EMPLOYEE
3.1 The Employee is required to contact the Agency’s representative immediately, or at least 72 hours before the Employee’s next shift, if and when the Employee:
a. becomes ill or suffers an injury while on assignment;
b. is late or can’t report for an assignment;
c. has a problem or query regarding an assignment.
d. changes his/her name, address or telephone number;
e. is contacted by the Client to return to the Client for a further assignment. If The Employee returns to any one of the Agency’s clients, the Agency must be informed immediately.
f. if the Employee is offered full-time employment with any of the Agency’s clients.
g. if the duties of the assignment are changed by the Client.
h. experiences a change in his / her medical condition, or state of health that could impact upon the Employee’s ability to carry out assignments, or his / her eligibility for assignments.
3.2 The Employee will wear his / her name badge at all times when attending the premises of a client.
3.3 The Employee will be at work on time and will advise the Agency and the Client timeously if he/she cannot for any reason be at work on time, or at all.
Consistent late coming and poor timekeeping, or any other transgressions will be dealt with in accordance with the disciplinary procedure and can result in dismissal.
4. AGENCY SERVICE AGREEMENT AND TERMS AND CONDITIONS OF EMPLOYMENT
4.1 Agreement Principle
a. This agreement sets out the terms of our relationship as the Employee’s Agent when on an assignment with the Agency.
b. The Agency is in the business of assigning temporary workers to its clients, for the purpose of providing a service to the client, for a temporary period determined by its clients.
c. By signing this agreement, the Agency will act as the Employee’s agent in securing, wherever possible, assignments for the Employee with its clients, for the purpose of providing a service to the client, for a temporary period determined by the client.
d. The Employee will advise the Agency immediately, if employment or an assignment is offered directly to the Employee by any Client of the Agency.
4.2 Relationship
a. For the duration of any assignment, the Agency as a Temporary Employment Service defined in terms of the Labour Relations Act of 1995, will constitute the Agency for the purposes of the Labour Relations Act.
b. During any period or period during which the Employee is not working on an assignment the Agency will not constitute the Employee’s employer but will remain the Employee’s agent and the Employee will not be an Employee for the purposes of the Labour Relations Act or any other law.
c. The Employee will be offered temporary assignments by the Agency from time to time, of such nature as the Agency in its discretion may determine, having regard for the Employee’s skills, expertise, and experience, in accordance with the requirements of the assignment as specified by the Client.
4.3 Expectation of Future Assignments
a. The Employee agrees that notwithstanding the Agency’s intention to secure assignments for the Employee on a regular basis for the duration of this agreement, the Employee has not been given any undertaking in this regard, nor has any expectation been created that the Employee will be placed in other assignments or that the Employee’s assignment in any future temporary position, will be on the same or similar terms to any previous assignment.
4.4 Termination, Notice Period, and expectation of Permanency
a. The positions in which the Employee may be assigned are of a temporary nature and will automatically terminate, without further notice to the Employee and unless terminated earlier as provided for below, either by the expiry of the fixed period relating to the assignment or upon the expiry of the specific task to which the Employee is assigned.
b. The nature, commencement, and duration of each assignment will be communicated to the Employee when the Employee is offered a temporary assignment by an Agency representative.
c. It is specifically recorded that there is no expectation that any assignment will automatically be renewed or prolonged for a period other than the one envisaged at the time of the commencement of the assignment.
The termination of any temporary assignment by the expiry of the fixed terms pre-advised will also not constitute a redundancy, dismissal, or retrenchment.
In these circumstances, the assignment shall automatically expire through the completion or fulfillment of the temporary assignment.
d. For each assignment, it will be communicated to the Employee, either in writing or orally by the representative of the Agency of the Employee’s hourly rate of pay, the Client’s company’s name and address, where the Employee is to report, the name of the person the Employee should report to, and details of the nature and hours of work.
The Employee will further be advised of the actual or anticipated duration of the assignment.
e. The assignment may be terminated, prior to its anticipated termination date, for the following reasons:
i) Misconduct by the Employee;
ii) Poor work performance of the Employee;
iii) The client prematurely terminating the assignment;
iv) The client insisting that the Employee must be removed or replaced for whatever reason.
f. It is specifically agreed that should the Employee’s temporary assignment be lawfully terminated before the expiry of the assignment, neither party will have any claim against each other, of any nature whatsoever, including, but not limited to a claim for damages, specific performance, or an unfair dismissal dispute.
4.5 Standard Terms of Employment
When the Employee accepts an assignment the Employee must be committed to the assignment and agree to the following:
a. To comply with terms and conditions of employment as set out in this Agreement as well as the Agency’s Disciplinary and Grievance Procedures in the Standard Operating Procedures (SOP’s), available for The Employee to read at the Employee request.
b. To comply fully with any rules, procedures, policies, and practices in place at the client’s premises which apply to the Employee’s assignment.
c. These include specific procedures that the Client adopts as part of its normal employment practices.
The Employee undertakes to familiarise him/herself with such specific procedures upon taking up his/her duties on assignment.
d. To accept that each assignment is of a temporary nature and that no benefits or conditions applying to permanent Employees of the Client or the Agency will apply to the Employee.
5. TERMINATION OF AGENCY AGREEMENT
This Agency Agreement, which governs the Employee’s general association with the Agency, may be terminated at any time, upon any grounds recognized in Law as being sufficient.
6. GENERAL
a. The Employee undertakes to further the interests of the Agency in all his/her actions at all times and to do everything reasonably necessary and ancillary to the competent, accurate, and efficient performance of his/her job function.
b. This document and its annexures and associated policies and procedures contain the entire agreement between the parties and no variation or cancellation by agreement of, addition or amendment to, or deletion from this agreement shall be of any force or effect unless in writing and signed by or on behalf of the parties hereto.
c. No indulgence granted by a party will constitute a waiver of any of that party’s rights under this agreement; accordingly, that party will not be precluded as a consequence of having granted such indulgence, from exercising any rights against the other which may have arisen in the past or which may arise in future.
d. The Agency is hereby authorised to access the Employee’s personal information and conduct background screening checks, including but not limited to, credit, qualifications, employment references, criminal record, fraud prevention, ID verification and driver’s license.
e. Within two (2) days of signature of this agreement the Employee is obliged to provide the Agency with a confirmation letter from its financial institution confirming its banking details in which he/she would receive payment of his/her remuneration.
f. The Employee must on request provide the Agency with certified copies of proof of his/her registration documents with his/her professional body as well as proof that the Employee’s annual registration is paid up to date.
g. The Employee must provide the Agency with proof of its Tax Income number by submitting to the Agency an official letter from SARS confirming the Tax Income Number.
h. The Employee must provide the Agency before accepting any assignments in the following documents:
(i) Certified copy of his/her South African Identity Document;
(ii) Certified copy of The Employee’s qualification;
(iii) If the Employee is a foreign citizen – Copy of his/her passport and right to work visa or refugee permit;
(iv) A certified annual receipt of payment or certified annual card of the relevant registered body as per point f above;
(v) Certified registration certificate of the relevant registered body as per point f above;
(vi) CV in Word or PDF format;
(vii) Certified marriage certificate should any names vary on any of the above documents.
7. DECLARATION
a. I declare the information given in this application form is true and complete to the best of my knowledge and belief.
I have read and understood the following:
(i) I have read and understood and agree to the contents of this document;
(ii) I have professional indemnity – I understand that I need to have professional indemnity cover in place at all temporary assignments and I will not undertake assignments without entrusting that this cover is in place;
(iii) I agree to comply with all Health & Safety Legislation and Regulations that are applicable;
(iv) I understand that my appointment is subject to the receipt of a minimum of two satisfactory references, which I give the Employer permission to contact and obtain.
(v) I agree to respect the confidentiality of patients and clients and any other information that I may have access to at all times;
(vi) I confirm that the selections made in Annexure “NEF” to this document is a true and correct record of the information it intends to convey;
(vii) I have read, understand, and agree to adhere to the Agency’s disciplinary code and grievance procedure.
(viii) RWOPS; I am aware that if I am employed in the Public Service, I must obtain permission to undertake agency work from my employer.
(ix) I am aware that if I have been convicted in terms of the Sexual Offences and Related Matters Amendment Act 32 of 2007, I must disclose such conviction to the Agency.
(x) I confirm that I am aware that I must disclose to the Agency if my name appears in Part B of the National Child Protection Register in terms of the Children’s Act, 38 of 2005.
(xi) I understand that it is my responsibility to have an annual clinical health screen at my own cost.
(xii) In the event that I become symptomatic while I am on assignment, I undertake to advise the Agency immediately.
(xiii) I undertake to ensure that I receive all relevant and necessary immunisations and vaccinations to prevent susceptibility to any communicable or infectious diseases.
(xiv) I have not been convicted of a criminal offense in any Country.
(xv) I have not been convicted or disciplined for professional misconduct and I do not have any pending professional misconduct proceedings against me in any Country.
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1932
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Nationality
*
ID/Passport Number
*
Gender
*
-
Male
Female
Other
Marital Status
*
-
Single
Married
Divorced
Widowed
Employment Equity
*
-
Black
Coloured
Indian
White
Other
Visa Type
*
Not Applicable
Work Visa
Business Visa
Home Language
*
Second Language
*
Other Languages
Home Telephone
Cell Number
*
Secondary Cell Number
Email
*
Home Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
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Côte d'Ivoire
Denmark
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Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Emergency Details
In an emergency, we'll use the details below to contact a preferred contact of yours.
Emergency Contact First Name
*
Last Name
*
Relationship
*
Contact Number
*
Professional References
This is a log of your previous work experience, only two are required.
Position One Held
*
Start Date
*
End Date
*
Institution
*
Contact Person
*
Contact Person Position
*
Contact Number
*
Position Two Held
*
Start Date
*
End Date
*
Institution
*
Contact Person
*
Contact Person Position
*
Contact Number
*
Other Position Held
Start Date
End Date
Institution
Contact Person
Contact Person Position
Contact Number
Banking and Tax Details
This is so that our finance department can pay you straight into your account.
Account Holder Name
*
Bank
*
Account Number
*
SARS Tax Registration Complete - Yes/No?
*
-
Yes
No
Tax Registration Number
*
Only working through Immploy - Yes/No?
*
-
Yes
No
If No, what Tax Percentage (%) should be deducted?
-
25%
30%
35%
41%
I have a current Tax Directive and I have provided this document to Immploy - Yes/No
*
-
Yes
No
Security Check
As employers, we need this information.
Do you have a criminal record?
*
If yes, specify.
Are you listed on the ITC?
*
If yes, specify,
Please attach the relevant documents listed below:
• Clear Photo for Name Badge • Identity Document/Passport • Visa and Passport (Where applicable) • Curriculum Vitae (Word or PDF format) • Proof of Registration with Regulatory Body • Proof of Tax Number • Statement of Academic Record/Transcript • Proof of Bank Account (Stamped) • Marriage Certificate/Name Change Documents
Upload and attach your documents here:
*
Click or drag files to this area to upload.
You can upload up to 10 files.
Accepted File Types: .jpg, .jpeg, .pdf, .png, .doc, .docx and .pptx
I confirm that I am aware of the annual leave options, and select:
*
-
Option One (All Inclusive)
Option Two (Accrual)
Skills Matrix
Please
tick only five (5)
job roles that you have been exposed to within the
last two (2) years.
Please select the division under which you fall:
*
-
Nursing
Doctors/Radiology
Pharmacy
Healthcare Professionals
Please be sure to choose the correct division. For example, do not complete the Pharmacy Skills Matrix if you are a Nurse or Doctor.
Nursing Skills
*
Casualty Trained
Casualty Experience
Community Clinics
PHC
CNP Trained
CNP Experienced
Dispensing Licence
Fertility Clinic
Termination Clinic
VCT Trained
VCT Experienced
PMTCT
Occupational Health Trained
Occupational Health Experienced
Home Care
Rehabilitation Centre
Stoma Care
General
Day Surgery
Surgical - General
Medical
In Charge Duties
Prisons
ICU Trained
ICU Experienced
ICU Psychiatric
NICU
PICU
High Dependency Unit
Vent Competent
NIMART Trained
Dispensing Certificate
IMCI Trained
BANC Trained
Doctors/Radiology Skills
*
MO Casualty - Casualty ACLS
MO Casualty - Casualty ALS
MO Casualty - Casualty ATLS
MO Casualty - Casualty BLS
MO Casualty - FMA
MO Casualty - Casualty PALS
MO Casualty Casualty- Emergency Medicine
MO General - GPMO General - General Medicine
MO General - GP Dispensing License
MO Primary - Family Planning
MO Primary - Termination of Pregnancy
MO Primary - OPDMO Primary - Internal Medicine
MO Primary - HIVMO Primary - TB
MO Paediatrics - Paediatrics
MO Paediatrics - Paediatrics General
MO Paediatrics - Paediatrics Surgery
MO Other - Disability Grant
MO Other - Forensic Medical Officer
MO Specialised - Anaesthetics
MO Specialised - ARV
MO Specialised - Audiology
MO Specialised - Aviation Medicine
MO Specialised - Biochemistry
MO Specialised - Cardiology Adult
MO Specialised - Cardiothoracic Surgery
MO Specialised - Dermatology Gastro
MO Specialised - Dermatology Geriatric
Emergency Medicine - ENT Surgery
Emergency Medicine - Gastroenterology
Emergency Medicine - Genito-urinary Medicine
Emergency Medicine - Geriatrics
Emergency Medicine - Good Clinical Practice
Emergency Medicine - Histology
Emergency Medicine - ICU
Emergency Medicine - Marine Medicine (Sports & Professional Driving)
Emergency Medicine - Medical Scientists
Emergency Medicine - Military
Emergency Medicine - Mountain Medicine
Emergency Medicine - Neonatal
Emergency Medicine - Nephrology
Emergency Medicine - Neurosurgery
Emergency Medicine - Obs & Gynae
Emergency Medicine - Occupational Health
Emergency Medicine - Oncology Ophthalmology
Emergency Medicine - Oral Surgery
Emergency Medicine - OrthopaedicsEmergency Medicine - Pathology
Emergency Medicine - Plastic Surgery
Emergency Medicine - Rheumatology
Emergency Medicine - Surgery
Emergency Medicine - TB
Emergency Medicine - Urology
Radiology - Radiologist
Radiology - Radiographer
Radiology - Nuclear Radiology
Radiology - Therapy
Radiology - Ultrasound
Radiology - Radiology
Radiology - Assistant Sonographer
Pharmacy Skills
*
Pharmacy Clinical - Clinical Pharmacist
Pharmacy Clinical - Clinical Pharmacist Assistant Basic
Pharmacy Clinical - Clinical Pharmacist Assistant Post Basic
Pharmacy Distribution - Distribution Pharmacist
Pharmacy Distribution - Distribution Pharmacist Assistant Basic
Pharmacy Distribution - Distribution Pharmacist Assistant Post Basic
Pharmacy Production - Production Pharmacist
Pharmacy Production - Production Pharmacist Assistant Basic
Pharmacy Production - Production Pharmacist Assistant Post Basic
Pharmacy Quality Assurance - QA Pharmacist
Pharmacy Quality Assurance - QA Pharmacist Assistant Basic
Pharmacy Quality Assurance - QA Pharmacist Assistant Post Basic
Pharmacy Hospital Private - Hospital Pharmacist
Pharmacy Hospital Private - Hospital Pharmacist Assistant Basic
Pharmacy Hospital Private - Hospital Pharmacist Assistant Post Basic
Pharmacy Hospital Government/CHC - Hospital Pharmacist
Pharmacy Hospital Government/CHC - Hospital Pharmacist Assistant Basic
Pharmacy Hospital Government/CHC - Hospital Pharmacist Assistant Post Basic
Pharmacy Retail - Pharmacist
Pharmacy Retail - Pharmacist Assistant Basic
Pharmacy Retail - Pharmacist Assistant Post Basic
Healtcare Professional Skills
*
HCP Dentistry - Dentist
HCP Dentistry - Dental Assistant
HCP Dentistry - Oral Hygienist
HCP Dentistry - Dental Therapist
HCP Specialist - Clinical Psychologist
HCP Specialist - Dieticians
HCP Specialist - Optometrists
HCP Specialist - Occupational Therapist
HCP Specialist - Speech Therapist
HCP Specialist - Audiologist
HCP Specialist - Physiotherapist
HCP Specialist - SHEQ Psychiatrist
HCP Specialist - Psychiatrist
HCP Specialist - Optical Dispenser
HCP Social Workers - Adolescents
HCP Social Workers - Adult
HCP Social Workers - Children
HCP Social Workers - Child Protection Worker
HCP Social Workers - Clinical Psychologists
HCP Social Workers - Counsellor
HCP Social Workers - Drug/Alcohol Abuse
HCP Social Workers - Educational Social Worker
HCP Social Workers - Elderly Family Centre Worker
HCP Social Workers - Fostering/Adoption Worker
HCP Social Workers - Generic/Duty Field Worker
HCP Social Workers - HIV
HCP Social Workers - Homeless
HCP Social Workers - IT Juvenile Justice Worker
HCP Social Workers - Learning Disability
HCP Social Workers - Mental Health
HCP Social Workers - Physically Disabled
HCP Social Workers - Probation Services
HCP Social Workers - Residential
HCP Social Workers - Senior Manager
HCP Social Workers - Sensory Impairment
HCP Social Workers - Social Work Trainer
HCP Social Workers - Speech Therapists/Audiologists
HCP Social Workers - Unqualified Social Worker
HCP Other - Administration Assistant
HCP Other - CSSD
HCP Other - Porter
HCP Other - Ward Clerk
HCP Other - Cleaner
HCP Other - Medical Receptionist
HCP Other - General Worker
HCP Other - Skilled Worker
HCP Other - Code 8 Driver
HCP Other - Code 10 Driver
HCP Other - Code 14 Driver
HCP Other - Forklift Driver
Accept Terms & Conditions
Terms & Conditions
*
I hereby accept the
Declaration Terms and Conditions
of the above-mentioned temporary contract with Immploy Medical Recruitment.
Candidate Name
*
First
Last
Date
*
Signature
*
Clear Signature
Message
Submit Application