For office use only

Serial Number

Registration Office

(Example: Olifantsfontein, Kimberley, Cape Town etc.) Application form

Department of Labour

Manpower Training act,, No 56 of 1981

Regulation 15, Annexure 8

PLEASE PRINT

1. Surname 2. First names 3. Identity number: 4. Date of birth: 5. Standard of education 6. For statistical purposes

(Please mark with an X)

African Female Male

Indian Female Male

Coloured Female Male

White Female Male

Other Specify

7. Residential address 8. Postal address 9. Telephone (Residential) Employer: 10. Cell number

11. Name and address of present employer

12. Present occupation 13. Trade in which assessment is required 14. Details of practical experience:

Name and address of employer From To Occupation

15. Details of previous assessment

Name any other previous assessments/

trade

Date Institution where

assessment took place

Passed or failed

Is the candidate under contract with a SETA or with Government? If yes, state. SETA

Receipt Number SKILLS DEVELOPMENT ACT,1998

SECTION 28 TRADE TEST APPLICATION

MEDICAL / LANGUAGE INFORMATION

NAME: ID NUMBER: TRADE: SERIAL NUMBER To be completed by registration officer) 1.a) Please indicate by means of a cross in the appropriate space here under, as to whether or not you suffer from any medical disorder or allergy, e.g. High blood pressure, sugar, epilepsy, etc. which requires any special attention with regard to attempting a trade test

1.b) If YES, state the nature of the disorder / allergy and whether or not you are under medical treatment

2.a) Please indicate if you have a problem with reading or writing 2.b) If you have, please discuss it with the person handling the application NOTES BY REGISTAR

3.a) Do you want to make use of the hostel facilities on the premises? 3.b) If no, would you like to have lunch at the hostel of a minimum cost? 4.c) Please indicate if you want your trade test report / certificate to be mailed or would you like to be contacted to self collect

SELF COLLECT

Contact person Contact no.

MAIL

Addressee: ADDRESS:

Code It is the candidate’s responsibility to ensure that his/her contact details are correct and updated at the office through which applied. Please do not discuss change of contact details with the examiners whilst on test or at the records office, Olifantsfontein

Candidate’s signature Registration officer Date YES NO

YES NO

YES NO

YES NO

Contact this candidate