Join Us – ShiftMatch Staffing Solutions

JOIN OUR NETWORK

1. Download the Application Pack

Get our Registration Form & Service Agreement to complete your application.

2. Submit Your Documents
Send your completed form along with certified copies of your ID, qualifications, professional registration, and other required documents.

3. Start Your Journey
Once approved, we’ll match you with the right shifts and opportunities

Requirements

Before you apply, make sure you have:

Certified copy of your ID

Professional registration with SANC or HPCSA

Proof of professional indemnity cover

Certified copies of your qualifications

Proof of Hepatitis B vaccination

Copy of your BLS certificate

ShiftMatch Solutions Registration Form

REGISTRATION FORM MEDICAL/NURSING

Complete all sections accurately and return with required documents

Printing Instructions: For best PDF results, use Chrome or Edge. Click "Print Form", then choose "Save as PDF" in the destination options. Set paper size to A4 and margins to "Default".

FOR OFFICE USE ONLY

SHC Number	Date Captured

PLEASE RETURN COMPLETED FORM WITH CERTIFIED COPIES OF THE FOLLOWING DOCUMENTATION TO SHIFTMATCH SOLUTIONS:

Certified copy of your identity document
Certified copy of professional registration (SANC/HPCSA)
Proof of professional indemnity
Certified copies of your qualifications
Proof of Hepatitis B Vaccine
Copy of BLS Certificate

Note: New applicants will ONLY be registered and issued with an SHC number if the form is completed in FULL and all supporting documents have been received.

1. PERSONAL INFORMATION

Surname	Full names
Title Mr. Mrs. Miss	Maiden Name
Known as	Marital Status
Identity Number	Date of Birth
Telephone (home)	Telephone (cell)
Telephone (work)	Email
Physical Address
Postal Address
Postal Code	Postal Code
Gender Male Female	Next of kin, relation, cell nr
Ethnic Group African Coloured Indian White

2. PROFESSIONAL INFORMATION

Professional Regulatory Body
SANC	HPCSA
SANC Number	Receipt Number
HPCSA Number	Receipt Number
Professional Indemnity Cover

It is a requirement of ShiftMatch Solutions that all assignees have indemnity cover against professional liability.

3. EDUCATIONAL INFORMATION

Qualification	Year Obtained



Professional Title (Pharmacist, RN, EN, ENA, CW)

TO BE COMPLETED BY NURSES ONLY

Specialty Area	Trained	Experienced
ICU/NICU/Theatre/Trauma	Yes	Yes
Competent in working with a ventilator Yes No
Do you have work experience in a Private Hospital? Yes No

4. WORK EXPERIENCE (NURSING ONLY)

Only tick applicable areas:

Specialized
GICU	CT ICU	TICU	SICU	MICU	CCU	Neuro ICU	PICU
NICU	Trauma	Casualty	High Care	Case Management	Other

Maternity
Antenatal	Labour	Post Natal	Nursery

Theatre
Anesthetic	Recovery	Scrub	Floor	CSSD	Cath Lab

General Wards
Surgical	Medical	Oncology	Ortho	Renal	Pediatric	Plastics	Other

5. PLACEMENT

List preferred hospitals/units in order of preference:

Do you want to be contacted for shifts in other hospitals/units?

Yes

6. EMPLOYMENT HISTORY

Name of Employer	Department	Position	Period Employed	Reason for Leaving

7. REFERENCES

Name	Hospital	Unit	Telephone Number

8. FINANCIAL INFORMATION

Bank Name
Branch Name
Branch Code
Account Number
Type of Account

9. TAX DECLARATION AND PAYMENTS

Weekly payments are made on a ______. Payments are made by electronic funds transfer (EFT) only. If ShiftMatch Solutions is your only employer (part time), tax will be deducted from your earnings in accordance with the weekly tax tables published annually by SARS. If you have other employment (full time), tax will be deducted at a flat rate of 25%. It is your responsibility to keep ShiftMatch Solutions updated of your employment status.

SARS Tax Tables (sessional: only working for agency)

Flat rate 25% (full time employed by hospital)

Tax Reference Number

Monthly payments for regular shift workers will be done at the end of every month.

MED WORX AND POST EXPOSURE PROPHYLAXIS COVER

It is a condition to have Post Exposure Prophylaxis Cover with Medworx when working for ShiftMatch Solutions.

10. TERMS AND CONDITIONS

I consent to ShiftMatch Solutions verifying my identity/qualifications through data sources.
I will not work two consecutive shifts in 24 hours.
I will not allow another person to supply services in my place.
I will uphold the values of ShiftMatch Solutions and its clients.
I will comply with ShiftMatch Solutions and client policies/procedures.
I will maintain updated Professional Indemnity cover.
ShiftMatch Solutions is excluded from liabilities arising from my duties.
I will provide renewed SANC registration to ShiftMatch Solutions.
Banking/surname changes must be communicated in writing.
Erroneous payments will be clawed back per agreement terms.
Uniforms must be worn per industry standards.
English is the official language.
I will comply with disciplinary procedures.
Sleeping on duty is a dismissible offence.
Cellphones must be switched off during duty.
Report 15 minutes before unpaid handover.
Cancel shifts with ≥4 hours notice.
PPE must be worn when required.
Follow OHS rules and report injuries immediately.
Provide Hepatitis B proof.
Hospital induction/orientation is compulsory.
CPDs are compulsory.
Termination notice: 1–30 calendar days (written).

All of the above is not exhausted. Contact ShiftMatch Solutions for any queries regarding rules, requirements, policies and procedures.

DECLARATION

I hereby declare that all particulars and responses in this application are TRUE and no required material has been withheld. I agree that the withholding of any information or failure to answer any questions honestly will constitute a breach of a condition of my employment for which I could face disciplinary action and possible dismissal.

Signed at (place)

Date

Signature

Witness