La Vie Academy Application Form
Programme Questions
QCTO Programmes (tick all interested)
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Home Based Caregiver Level 1
Home Based Caregiver Level 2
Home Based Caregiver Level 3
Basic Fire Fighter
Basic Emergency First Aid Responder Level 1
Intermediate First Aid Responder Level 2
Advanced First Aid Responder Level 3
SHE Rep
Health Care Cleaner Level 1
Health Care Cleaner Level 2
Food Hygiene
La Vie Group Programmes
La Vie Policies
La Vie Orientation
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Personal Details
Title
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Surname
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First name
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Known name
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ID/Passport Number
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Gender
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Male
Female
Ethnicity for QCTO reporting
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African
Coloured
Indian
White
Other
Email Address
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example@example.com
Work Phone Number
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Please enter a valid phone number.
Cellphone Number
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Please enter a valid phone number.
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Highest Qualification
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Grade 10
Grade 11
Grade 12
Certificate
Diploma
Degree
Honours Degree
Masters Degree
Name of highest qualification
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Place where highest qualification was obtained
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Year highest qualification was obtained
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Are you a La Vie Group applicant?
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Yes
No
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La Vie Group Applicant Questions
If you are not an applicant from La Vie Group, please return to the previous section and reselect.
La Vie Care Facility
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Brentmed
Dalemed
Elmed
Lynnmed
Nieuwmed
Northmed
Oosmed
Watermed
Medwell
LVC Employee Number
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Write 'None' if you are from Medwell
Current Position
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Cleaner
Careworker
Registered Nurse
Enrolled Nurse
Auxiliary Nurse
Ancillary Nurse
Facility Manager
Administration
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External Applicant Questions
If you are an applicant from La Vie Group, please return to the previous section and reselect.
Company name
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Current position
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Company department
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Short description of work experience
*
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Documentation to be uploaded
Certified copy of ID of passport
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Browse Files
Drag and drop files here
Choose a file
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Certified copy of highest qualification
*
Browse Files
Drag and drop files here
Choose a file
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Declaration by Applicant
By accepting this form, I agree to comply with all the requirements of my enrolment and accept the rules and regulations governing the Programme.
Full names
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Accept
*
Yes
Date
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Day
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Month
Year
Date
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