<p> SP 01 – Version August 2013</p><p>REGISTRATION OF A LEARNER ON A SKILLS PROGRAMME</p><p>SECTION 1 - LEARNER/PERSONAL INFORMATION1 WHAT IS THE PURPOSE Title: OF THIS FORM Mr Mrs Miss Other – (Specify): First Names: To enrol a learner on a skills programme. Middle Name(s): Yes WHO SHOULD Surname: Employed: No COMPLETE THIS FORM Identity No: Type of ID: RSA</p><p>For skills programmes Non-RSA quality assured by RSA Other (Specify): Nationality: SASSETA, all learners If OTHER, attach certified copies of documents indicating your status e.g. Permanent residence, Study permit, must register. etc. In the case of skills (ccyy/mm/dd Date of birth: Age: programmes quality ) assured by other ETQA’s, Gender: Male Female only learners employed by SASSETA registered Population Group African Coloured Indian White Other (Specify): employers should Do you have a disability2, as contemplated in the Employment Equity Act 55 of register. 19982? No Yes (Specify): LEARNER CONTACT DETAILS: (You must provide at least one phone number where you can be reached. Both physical AND postal addresses WHERE SHOULD THIS MUST be completed.) FORM GO Tel No (H): Tel No (W):</p><p>SASSETA Central Registry Mobile No: Fax No: Riverview Office Park Janadel Avenue E-mail: (Off Bekker Road)</p><p>Halfway Gardens Postal Address: P O Box 7612 Halfway House Code: Midrand Residential Address: 1685 Rural/Urban Area? Code: Local/District Municipality: FURTHER INSTRUCTIONS Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Province: 1. This form should be Mpumalanga Northern Cape North West Western Cape completed in full using black ink. LEARNER GENERAL DETAILS: 2. A certified copy of Highest School Qualification: the applicant’s ID Highest Qualification: must be attached to Home Language: this application. SECTION 2 - SKILLS DEVELOPMENT PROVIDER: (MUST be completed) Copies of certified copies or faxed Provider’s Registered Name: copies are not acceptable. SASSETA Accreditation Number: Other ETQA Accreditation Private/Public Provider? Number: (if applicable) CONTACT PERSON:</p><p>Title: Mr Mrs Miss Other – (Specify):</p><p>Surname: Name/s:</p><p>Tel No: Fax No:</p><p>E-mail: Contact ID No.:</p><p>1 Please note that the information requested above is required for statistical and reporting purposes. 2 2The Employment Equity Act, 55 of 1998, defines a disability as a long-term or recurring physical or mental impairment, which substantially limits prospects of entry into, or advancement in, employment.</p><p>Patrol Officer Page 1 of 2 SECTION 3 – SKILLS PROGRAMME DETAILS (NOTE: A Skills Programme is defined as “a predefined grouping of Unit Standards that form part of a NQF registered Qualification”). </p><p>Skills Programme Title: PATROL OFFICER SASSETA ID: 19S0000091</p><p>Qualification as per OFO National Certificate: General Security Practices NQF Level 03 OFO Code 541401 Unit Standard Explain the requirements for becoming a security service provider Credit value: 4 SAQA ID: 246694 Unit Standard Conduct a security patrol in area of responsibility Credit value: 7 SAQA ID: 244177 Unit Standard Apply legal aspects in a security environment Credit value: 8 SAQA ID: 244184 Unit Standard Use security equipment Credit value: 2 SAQA ID: 244176 Unit Standard Handle complaints and problems Credit value: 6 SAQA ID: 244179 Unit Standard Perform hand over and take over responsibilities Credit value: 2 SAQA ID: 244181 Unit Standard Give evidence in court Credit value: 4 SAQA ID: 244182 Unit Standard Perform basic fire fighting Credit value: 5 SAQA ID: 12484 Unit Standard Provide risk base primary emergency care/first aid in the workplace Credit value: 5 SAQA ID: 120496 Unit Standard Credit value: SAQA ID: Total Credits: Learner Enrolment Date: Programme Start Date: Is the programme Amount per learner SETA/Industry funded?</p><p>SECTION 4 – EMPLOYER DETAILS (This Section MUST be completed for employed learners) Name of the Employer: Employer SDL Number: L 0 7</p><p>Business Address: Code:</p><p>Postal Address: Code: CONTACT PERSON: Title:  Mr  Mrs  Miss  Other – (Specify): Surname: Name/s: Tel No: Fax No: E-mail: Contact ID No</p><p>SECTION 5 - DECLARATION BY APPLICANT (MUST be completed)</p><p>I, ______(full names), declare, to the best of my knowledge, that all the information provided is complete and correct. Signed at ______on this, the _____ day of ______20______.</p><p>______Applicant Learner</p><p>Patrol Officer Page 2 of 2</p>