Registration Form Basic InformationPlease enter your information belowFirst Name *Middle NameLast NamePhoneEmail AddressDate of BirthDoBGender *MaleFemalePrefer Not to AnswerID or Passport No. *Do you have any disability or declared medically unfit? *NationalityWhich country are you from?What is your highest level of education? *Which courses are you applying for? *Mining or Machine Operator CoursesSafety CoursesWelding CoursesVocational SkillsTruck Driving (Transport) CoursesSelect the vocational skillBasic PlumbingInstall Pressure PipesPipe fittingSelect the welding or boiler making courseSelect welding or boilermaker courseAgony WeldingArc WeldingCO2 weldingBoilermakingSelect the safety course(s) you are applying forBasic First AidBasic Fire FightingApplying SHE principlesSafety OfficerSafety for SupervisorWorking at HeightsSHE representativeDangerous Goods TrainingRisk Assessment TrainingOHS regislationsAccident/Incident InvestigationsUnderstand and deal with HIV/AIDSSelect the truck courseSelect the truckSuperlink Truck TrainingHorse and Trailer TrainingCode 10 Truck TrainingSide Tipper Truck TrainingMost of these trucks require either code 10 or code 14 drivers licenseSelect the mining or machine operator course you are applying for *Machine nameForklift TrainingExcavator TrainingGrader TrainingDump Truck TrainingFront End Loader Training777 Dump Truck TrainingTractor Loader Backhoe (TLB) TrainingSkid Steer Loader (Bobcat) TrainingOverhead Crane TrainingTower Crane TrainingTruck Mounted Crane TrainingTelescopic Handler TrainingLHD Scoop TrainingBulldozer TrainingRoller TrainingReach Truck TrainingReach Stacker TrainingRoller TrainingMobile Crane TrainingGrade to Final Levels ( Grader)Water Cart TrainingFace Shovel TrainingDrill Rig TrainingCherry Picker Truck TrainingScissor Lift TrainingBoom Lift TrainingPowered Pallet Truck (PPT) TrainingWhen are you starting your course?Remember you can start at any time. Please indicate the exact date you will be ready to start the course.AddressStreet Address *Apartment, suite, etcCity *State/Province *ZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweUpload files hereDrag and Drop (or) Choose FilesUpload copy of ID, License, QualificationsEmergencyDetails of the person to contact in case of an emergencyFirst Name *Middle NameLast Name *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone *Email AddressRelationshipHow are you related to this person? Brother, Sister, Mother, Father, UncleOther DetailsDo you plan to study another course in future?YesNoWhich course will you study in future?Are you currently employed?YesNoAre you open to new opportunities?Should we contact you in case there is a job available which requires your skill?Payment DetailsWhich method of payment are you planning to use?CashBankCardACCOUNT DETAILS: ACC Name WHEELSET ACADEMY OF MACHINE OPERATORS ACC NO 62862273390 BANK First National Bank (FNB) REFERENCE Name or Reg no. or ID no. I agree to the following: *YesNoTerms and conditions I certify that the above information provided by me/us is correct. I undertake to submit all the documents in original for verification. Learner code of conduct I will attend all the classes and activities listed on the training schedule for the course for which I am registered. If I am not able to attend any of the above−mentioned activities due to unforeseen circumstances, I will inform the academy. If I neglect to do so I must explain my actions to the disciplinary committee (verbally and in writing). I will take responsibility for my learning both in the classroom, at home or practical site. I will study the sections in my training manual stipulated as self−study. I will submit my portfolio of projects for assessment on the agreed dates and in the manner prescribed by facilitator. I undertake to attend both the classroom and practical training. I understand that an attendance register will be kept by the facilitator and that failure to attend will result in my not being found competent, as I will have failed to complete the required number of training hours. Apply
