ICT Onboarding — Crestcare

Identity

Title *

First Name(s) *

Surname *

Employee Number *

Employee Start Date *

Line Manager Name & Surname *

Line Manager Email *

Is there allocated budget?

Yes No

Role & Location

Company Role *

Hospital *

Department *

Contact Numbers

Mobile Number *

Office Number

Peripherals & Connectivity

Wi-Fi Access Required?

Yes No

Scan to Email Required?

Yes No

📍 Printer details required

Printer Location & Name for Scan to Email

Label Printer Access

Normal Printer Access

Supporting Documents

Optionally attach supporting documents (e.g. signed authorisation, ID copy). Accepted: .txt, .docx, .png, .jpg / .jpeg — max 10 MB each.

Drag & drop files here

or use the buttons below

Privacy Statement

Crestcare is committed to protecting your privacy. The personal information you provide through this form will be collected and used solely for the purpose of creating authorised access to the Crestcare ICT Systems. We will share your information with third parties for the sole purpose of granting systems access and configuration only. Your data will be stored securely and retained only as long as necessary to fulfill the stated purpose. By submitting this form, you acknowledge that you have read and understood this privacy statement.

If you have any concerns please contact: peter@crestcare.co.za

Do you agree to the Privacy Statement? *

✓ I Agree ✕ I Decline

You should agree to the Privacy Statement to submit this form.

ICT Onboarding Request