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Course Registration Form: Mining Operations Training Centre

This document is a course registration form for the Mining Operations Training Centre in Okahandja, Namibia. It collects personal information such as name, contact details, nationality, occupation, driver's license information, medical information, and method of payment for an upcoming mining operations training course. The form notes that full payment is due 7 days before the course start date and that cancellation fees apply. It also states that some trainee information may be shared with payers and future employers and will be used to improve training materials.

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MOTCNAM
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85 views

Course Registration Form: Mining Operations Training Centre

This document is a course registration form for the Mining Operations Training Centre in Okahandja, Namibia. It collects personal information such as name, contact details, nationality, occupation, driver's license information, medical information, and method of payment for an upcoming mining operations training course. The form notes that full payment is due 7 days before the course start date and that cancellation fees apply. It also states that some trainee information may be shared with payers and future employers and will be used to improve training materials.

Uploaded by

MOTCNAM
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MINING OPERATIONS TRAINING CENTRE

P.O. BOX 1640


OKAHANDJA
Tel: +264 81 124 7814
Fax: 0886 55 33 44
E-mail: [email protected]
www.facebook.com/motcnamibia
www.motc.com.na


COURSE REGISTRATION FORM
(Fields marked with * are compulsory)
Date: Course:
Course ID
Code:
Course Dates:
Course
duration:
(days)
PERSONAL INFORMATION
*TRAINEE Surname: *First: *Middle:
Mr.
Mrs.
Miss
Ms.
Marital status (circle one)
Single / Mar / Div / Sep / Wid
*Nationality: *ID / Passport number: Birth date: Age: Sex:


(dd/mm/yyyy)
M F
Street address: Social Security no.: *Mobile phone no.:
( )
P.O. box: *City: Region: *E-mail address:

*Current Occupation: Employer: Employer phone no.:
( )

REQUIRED TRAINING INFORMATION
Are you in possession of a valid
drivers license, code CE:
Drivers License Number:
Have you had any vehicular / earthmoving
equipment accidents:
Yes No Yes No
If you had any vehicular / earthmoving equipment
accidents, please explain: (when it happened, what
happened, where it happened.)

Do you wear glasses / contact lenses
for far sight and driving:
For statistical purposes, please indicate your Ethnic
background (optional only):
Highest level of education
obtained:
Yes No
Please describe any physical limitations or learning
disabilities you have and have these limitations or
disabilities previously prevented you from driving or ever
caused you to be the cause of an accident:

Please list any medications you
are required to take regularly:

Please indicate which of the following services you
will require for the duration of your training:
No Accommodation
required
Provide accommodation
Method of payment: Cash EFT (Internet Banking)
Please note that full payment for the course and accommodation (if selected) is due 7 days before the commencement date of the
course.
I certify that the above information provided is correct. Portions of trainee file information may be shared with payers of account and
future employers. Information obtained will be used for data base building and to improve training course materials. Cancellation fees
are applicable.

Applicant signature: Date:

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