REGISTRATION FORM
Before proceeding in completing this document, ensure that you have the following documents available that must be uploaded.
Certified CLEAR COPY OF ID Document (If you have the ID card the front and back of the ID card need to reflect on one page and Certified).
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Certified CLEAR COPY of Grade 12 Certificate.
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Proof of official bank statement.
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Proof of Address: for example:
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Bank statement, or; Municipal account, or; Tax certificate, or; Lease or rental agreement, or; Declaration of residence.
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IF YOU ARE ON AN EXISTING (1) ETI PROGRAMME, (2)A STUDENT OR (3) EMPLOYED, YOU MAY NOT SUBMIT AN APPLICATION
Title
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Mr
Mrs
Miss
Ms
Name
*
First Name
Last Name
Second Name (-s)
Age
*
Gender
*
Male
Female
Home Language
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Race
*
African
Coloured
White
Indian
Other
Disability
*
Yes
No
If Yes: Please indicate the nature of disability
ID / Passport nr
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Married
*
Yes
No
Date of Birth
*
-
Month
-
Day
Year
Date
Nationality:
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RSA
Other
If you are not a citizen by birth, please indicate the date you acquired your citizenship.
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Month
-
Day
Year
Date
Residential Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Postal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell No
*
Please enter a valid phone number.
Format: (000) 000-0000.
WhatsApp No: (if different)
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Next of Kin Name
*
First Name
Last Name
Next of Kin Contact Details
*
Please enter a valid phone number.
Format: (000) 000-0000.
Friends Name
First Name
Last Name
Friends Contact Details
Please enter a valid phone number.
Format: (000) 000-0000.
BANKING DETAILS
(This is for your salary/stipend)
Account Holder’s Name
*
First Name
Last Name
Bank Name
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Branch Code/Name
*
Account type
*
Account number
*
Account number (Confirm again)
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Tax no
DECLARATION
I HEREBY DECLARE THAT I AM:
A recipient of SASSA Grants
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Yes
No
A recipient of UIF Grants
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Yes
No
Registered for ETI
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Yes
No
A full-time student
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Yes
No
Receiving a salary/stipend
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Yes
No
CHECK (A) (B) (C) AS APPLICABLE
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(A)I am not presently employed in any capacity and do not anticipate becoming employed within the next 8 months.
(B)I am not presently employed in any capacity but do anticipate becoming employed within the next 8 months, I do not yet have a job offer.
(C)I am not presently employed in any capacity, but anticipate becoming employed within the next 8 months and I have accepted a position with ______________________which will begin on __________________________
I confirm that I understand that providing false or misleading information herein constitutes an act of fraud. False, misleading, or incomplete information may result in the termination of the processing of this application. I confirm that I will actively participate in this programme and adhere to the daily instructions.
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Date
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-
Month
-
Day
Year
Date
Signed at (Current city)
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Today's date (Current day)
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Current Month
*
Current Year
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Previous Work Experience:
CURRICULUM VITAE
I have worked before:
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Yes
No
Employer 1:
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Date of emplyment
*
-
Month
-
Day
Year
Date
Responsibilities
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Employer 2:
Date of employment
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Month
-
Day
Year
Date
Responsibilities
Reference 1 name
First Name
Last Name
Reference 1 phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 2 name
First Name
Last Name
Reference 2 phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Provide a short description of who you are, what you want to achieve and your hobbies.
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