LEARNER DETAILS. Surname: First Names: ID Number: Place of Birth: Area Code:
LEARNER DETAILS. 1.1 Full name:
1.2 Identity number:
1.3 Date of birth: _
1.4 Gender: Male Female
1.5 Race: African Indian Coloured White
1.6 Do you have a disability, as contemplated by the Employment Equity Act, 1998? Yes (specify):
1.7 Learners residential, home and birth place addresses:
1.8 Contact telephone numbers: _
1.9 Postal address (if different from residential):
1.10 E-mail address:
1.11 Are you a South African citizen? YES NO If No, (specify and attach documents indicating your status including citizenship and/or permanent residence, study permit, etc.
1.12 Were you employed by your employer before concluding this agreement? YES NO
1.13 Were you party to a workplace-based learning programme agreement at any time in the past before concluding this agreement? YES NO
LEARNER DETAILS. (a) All personal details you provide to Xxxxxxxx at the time of regifration muf be accurate and complete. You muf also disclose to Grifith anything that may adversely impa4 on your ability to complete your chosen Short Course. During the Short Couse, you muf continue to disclose to Xxxxxxxx any information that would reasonably be considered relevant to your regifration or continued participation in the Short Course.
(b) You muf maintain a current email address for the duration of your Short Course and Xxxxxxxx will officially communicate with you via that email. You muf access your emails regularly while participating in the Short Course and you take responsibility to read any communication from Xxxxxxxx relating to your Short Course.
LEARNER DETAILS. 1.1 Full name XXXXXXX XXXXXX XXXXXXX
1.2 Identity number: 9712095218088
1.3 Date of birth: 09/12/1997
1.4 Sex : Male Female
1.5 Race: African Indian
1.6 Do you have a disability, as contemplated by the Employment Equity Act, 1998 (Act 55 of 1998) Yes (specify): N/A
1.7 Learners residential, home and birth place address: 00 xx Xxxxx xxxxxx Xxxxxxxx Xxxxxxxxxxxx (Company name starts with letters T - Z) Mangaung Metropolitan Municipality
1.8 Contact telephone numbers: (As many contact numbers as possible. ONE MUST be a cell number)
1.9 Postal address (if different from residential): 00 xx Xxxxx xxxxxx Xxxxxxxx Xxxxxxxxxxxx (Company name starts with letters T - Z) Mangaung Metropolitan Municipality Birth address:
1.10 E-mail address: xxxxxxx@xxxx.xx.xx
1.11 Are you a South African citizen? YES NO If No specify
1.12 Were you employed by your employer before concluding this agreement? YES NO
1.13 Were you party to a Workplace based learning programme agreement at any time in the past before concluding this agreement? YES NO
LEARNER DETAILS. 1.1 Full name:
1.2 Identity number:
LEARNER DETAILS. 1.1 Full name:
1.2 Identity number:
1.3 Date of birth: Male Female
1.4 Sex:
1.5 Race: African Indian Coloured White
1.6 Do you have a disability, as contemplated by the Employment Equity Act, 1998 (Act 55 of 1998)1 Yes (specify): No
1.7 Learners residential, home and birth place addresses:
1.8 Contact telephone numbers:
1.9 Postal address (if different from residential):
1.10 E-mail address:
1.11 Are you a South African citizen? Yes No If No, (specify and attach documents indicating your status including citizenship and/or permanent residence, study permit, etc.
1.12 Were you employed by your employer before concluding this agreement? Yes No
1.13 Were you party to a workplace-based learning programme agreement at any time in the past before concluding this agreement? Yes No
LEARNER DETAILS. 1.1. Full Name:
1.2. Identity Number:
1.3. Date of Birth:
1.4. Sex: Male Female Document Title Work-based Learning Programme Agreement
1.5. Race: African Indian Coloured White
1.6. Do you have a disability, as contemplated by the Employment Equity Act, 1998(Act 55 of 1998) No
1.7. Learners residential, home and birth place addresses:
1.8. Contact telephone numbers:
1.9. Postal address(if different from residential):
1.10. E-mail address:
1.11. Are you a South African citizen? Yes No If no, (specify and attach documents indicating your status including citizenship and/ or permanent residence, study permit, etc.
1.12. Were you employed by your employer before concluding this agreement? Yes No
1.13. Were you party to a workplace-based learning programme agreement at any time in the past before concluding this agreement? Yes No
LEARNER DETAILS. 2.1 Surname:
2.2 Full Names:
2.3 South African Identity Number:
2.4 Date of birth: Age (to date) 2.5 Persal number (if section 18.1 learner):
2.6 Gender:
2.7 Race:
2.8 Do you have a disability1, as contemplated by the Employment Equity Act 55 of 1998?1. Answer Yes or No. If yes, specify nature of disability: (Code)
LEARNER DETAILS. 4.1 Full Name as per ID:
4.2 Surname:
4.3 Identity Number:
4.4 Date of Birth:
4.5 Age:
4.6 Gender 4.7 Do you have a disability: Yes No
4.7.1 If yes ,specify and attach confirmation:
LEARNER DETAILS. Full name: __________________________________________________________ Identity number: _____________________________________________________ Date of birth: ________________________________________________________
