REGISTRATION OF A LEARNER ON A SKILLS PROGRAMME

WHAT IS THE PURPOSE OF THIS FORM
To enrol a learner on a skills programme.
WHO SHOULD COMPLETE THIS FORM
For skills programmes quality assured by SASSETA, all learners must register.
In the case of skills programmes quality assured by other ETQA’s, only learners employed by SASSETA registered employers should register.
WHERE SHOULD THIS FORM GO
SASSETA Central Registry
Riverview Office Park
Janadel Avenue
(Off Bekker Road)
Halfway Gardens
P O Box 7612
Halfway House
Midrand
1685
FURTHER INSTRUCTIONS
  1. This form should be completed in full using black ink.
  2. A certified copy of the applicant’s ID must be attached to this application. Copies of certified copies or faxed copies are not acceptable.
/ SECTION 1 - LEARNER/PERSONAL INFORMATION[1]
Title: / Mr Mrs Miss Other – (Specify):
First Names:
Middle Name(s):
Surname: / Employed: / Yes
No
Identity No: / Type of ID: / RSA
Non-RSA
Nationality: / RSA Other(Specify):
If OTHER, attach certified copies of documents indicating your status e.g. Permanent residence, Study permit, etc.
Date of birth: / (ccyy/mm/dd) / Age:
Gender: /
Male Female
Population Group / African Coloured Indian White Other (Specify):
Do you have a disability2, as contemplated in the Employment Equity Act 55 of 1998[2]? / No Yes (Specify):
LEARNER CONTACT DETAILS: (You must provide at least one phone number where you can be reached. Both physical AND postal addresses MUST be completed.)
Tel No (H): / Tel No (W):
Mobile No: / Fax No:
E-mail:
Postal Address:
Code:
Residential Address:
Rural/Urban Area? / Code:
Local/District Municipality:
Province: / Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo
Mpumalanga Northern Cape North West Western Cape
LEARNER GENERAL DETAILS:
Highest School Qualification:
Highest Qualification:
Home Language:
SECTION 2 - SKILLS DEVELOPMENT PROVIDER: (MUST be completed)
Provider’s Registered Name:
SASSETA Accreditation Number:
Other ETQA Accreditation Number: (if applicable) / Private/Public Provider?
CONTACT PERSON:
Title: / Mr Mrs Miss Other – (Specify):
Surname: / Name/s:
Tel No: / Fax No:
E-mail: / Contact
ID No.:

Page 1 of 3

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”).
Skills Programme Title: / Patrol Officer / SASSETA ID: / 19S0000091
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 SETA/Industry funded? / Amount per learner
SECTION 4 – EMPLOYER DETAILS
(This Section MUST be completed for employed learners)
Name of the Employer:
Employer SDL Number: / L / 0 / 7
Business Address:
Code:
Postal Address:
Code:
CONTACT PERSON:
Title: /  Mr Mrs  Miss  Other – (Specify):
Surname: / Name/s:
Tel No: / Fax No:
E-mail: / Contact ID No
SECTION 5 - DECLARATION BY APPLICANT (MUST be completed)
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______.
______
Applicant Learner

Patrol OfficerPage 1 of 2

[1] Please note that the information requested above is required for statistical and reporting purposes.

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.