Your IP : 216.73.217.79
<html>
<head>
<title>MentaNet</title>
<link href="style.css" rel="stylesheet" type="text/css" />
<style>
p, td {
font: 12px Verdana, sans-serif;
}
</style>
</head>
<body class="twoColFixLtHdr">
<div id="container">
<?php include("inc_header.php"); ?>
<div id="mainContent">
<?php
$bCourseFull = true;
if (isset($_GET["override"]) && ($_GET["override"]==1)) $bCourseFull = false;
if ($bCourseFull) {
?>
<p style='color:red'><b>Sorry, no more registrations can be accepted.</b></p>
<?php
} else {
//error_reporting(E_ALL);
//ini_set("display_errors", 1);
$pagetitle="CCM Registration";
include("../php/inc_db.php");
$sMsg = "";
$bShowForm = true;
function GenPassword() {
// Password generation
$length = 8; // Must be a multiple of 2
$conso=array("b","c","d","f","g","h","j","k","l", "m","n","p","r","s","t","v","w","x","y","z");
$vocal=array("a","e","i","o","u");
$password="";
srand ((double)microtime()*1000000);
$max = $length/2;
for($i=1; $i<=$max; $i++)
{
$password.=$conso[rand(0,19)];
$password.=$vocal[rand(0,4)];
}
return $password;
}
function WriteOptions($sSelName, $arr) {
for ($a=0; $a<count($arr); $a++) {
$sel="";
if ($_REQUEST[$sSelName]==$arr[$a]) $sel=" selected";
echo "<option value='".addslashes($arr[$a])."'".$sel.">".$arr[$a]."</option>";
}
}
if (isset($_POST["go"]) && ($_POST["go"]==1)) {
// $bCourseFull = true;
if ($bCourseFull) {
echo "<p style='color:red'><b>Sorry, no more registrations can be accepted.</b></p>";
} else {
if (empty($_POST['FirstName'])) {
$sMsg .= "<li>Please enter your first name</li>";
}
if (empty($_POST['Surname'])) {
$sMsg .= "<li>Please enter your surname</li>";
}
if (empty($_POST['EmailAddress'])) {
$sMsg .= "<li>Please enter your email address</li>";
}
if (empty($_POST['IDNumber'])) {
$sMsg .= "<li>Please enter your ID Number</li>";
}
if ($_POST['ti'] != md5($_POST['security_code'])) {
// The CAPTCHA code was incorrect
$sMsg .= "<li>You have provided an invalid verification code</li>";
}
if (empty($_POST['Accept_Policy'])) {
$sMsg .= "<li>You have not accepted the payment terms and conditions</li>";
}
if (empty($sMsg)) {
$bShowForm = false;
$sql = "SELECT * FROM CCMStudents WHERE IDNumber='".$_REQUEST["IDNumber"]."'";
$recCheck = mysql_query($sql);
if ($rowCheck=mysql_fetch_assoc($recCheck)) {
$sMsg .= "<li>The ID number you provided is already registered.</li>";
$bShowForm=true;
}
mysql_free_result($recCheck);
}
if (empty($sMsg)) {
$uploaddir = 'ccmadmin/uploads/';
$uploadID="";
$uploadCV="";
$uploadqual1="";
$uploadqual2="";
$uploadqual3="";
$uploadmentor="";
$uploadcandu="";
$uploadpolicy="";
$uploaddisability="";
$uploadpayslip="";
$uploadbank="";
$uploadphoto="";
$uploadfileID="";
$uploadfileCV="";
$uploadfilequal1="";
$uploadfilequal2="";
$uploadfilequal3="";
$uploadfilementor="";
$uploadfilecandu="";
$uploadfilepolicy="";
$uploadfiledisability="";
$uploadfilepayslip="";
$uploadfilebank="";
$uploadfilephoto="";
if (isset($_FILES['IDFile'])) {
$uploadID = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['IDFile']['name']))));
$uploadfileID = $uploaddir . $uploadID;
$ifilenum=1;
while (file_exists($uploadfileID) && !empty($uploadID)) {
$uploadfileID = $uploaddir . $ifilenum."_".$uploadID;
$ifilenum++;
}
move_uploaded_file($_FILES['IDFile']['tmp_name'], $uploadfileID);
}
if (isset($_FILES['CVFile'])) {
$uploadCV = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['CVFile']['name']))));
$uploadfileCV = $uploaddir . $uploadCV;
$ifilenum=1;
while (file_exists($uploadfileCV) && !empty($uploadCV)) {
$uploadfileCV = $uploaddir . $ifilenum."_".$uploadCV;
$ifilenum++;
}
move_uploaded_file($_FILES['CVFile']['tmp_name'], $uploadfileCV);
}
if (isset($_FILES['QualCertificate1'])) {
$uploadqual1 = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['QualCertificate1']['name']))));
$uploadfilequal1 = $uploaddir . $uploadqual1;
$ifilenum=1;
while (file_exists($uploadfilequal1) && !empty($uploadqual1)) {
$uploadfilequal1 = $uploaddir . $ifilenum."_".$uploadqual1;
$ifilenum++;
}
move_uploaded_file($_FILES['QualCertificate1']['tmp_name'], $uploadfilequal1);
}
if (isset($_FILES['QualCertificate2'])) {
$uploadqual2 = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['QualCertificate2']['name']))));
$uploadfilequal2 = $uploaddir . $uploadqual2;
$ifilenum=1;
while (file_exists($uploadfilequal2) && !empty($uploadqual2)) {
$uploadfilequal2 = $uploaddir . $ifilenum."_".$uploadqual2;
$ifilenum++;
}
move_uploaded_file($_FILES['QualCertificate2']['tmp_name'], $uploadfilequal2);
}
if (isset($_FILES['QualCertificate3'])) {
$uploadqual3 = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['QualCertificate3']['name']))));
$uploadfilequal3 = $uploaddir . $uploadqual3;
$ifilenum=1;
while (file_exists($uploadfilequal3) && !empty($uploadqual3)) {
$uploadfilequal3 = $uploaddir . $ifilenum."_".$uploadqual3;
$ifilenum++;
}
move_uploaded_file($_FILES['QualCertificate3']['tmp_name'], $uploadfilequal3);
}
if (isset($_FILES['MentorUndertaking'])) {
$uploadmentor = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['MentorUndertaking']['name']))));
$uploadfilementor = $uploaddir . $uploadmentor;
$ifilenum=1;
while (file_exists($uploadfilementor) && !empty($uploadmentor)) {
$uploadfilementor = $uploaddir . $ifilenum."_".$uploadmentor;
$ifilenum++;
}
move_uploaded_file($_FILES['MentorUndertaking']['tmp_name'], $uploadfilementor);
}
if (isset($_FILES['CandUUndertaking'])) {
$uploadcandu = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['CandUUndertaking']['name']))));
$uploadfilecandu = $uploaddir . $uploadcandu;
$ifilenum=1;
while (file_exists($uploadfilecandu) && !empty($uploadcandu)) {
$uploadfilecandu = $uploaddir . $ifilenum."_".$uploadcandu;
$ifilenum++;
}
move_uploaded_file($_FILES['CandUUndertaking']['tmp_name'], $uploadfilecandu);
}
if (isset($_FILES['CompanyCandidatePolicy'])) {
$uploadpolicy = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['CompanyCandidatePolicy']['name']))));
$uploadfilepolicy = $uploaddir . $uploadpolicy;
$ifilenum=1;
while (file_exists($uploadfilepolicy) && !empty($uploadpolicy)) {
$uploadfilepolicy = $uploaddir . $ifilenum."_".$uploadpolicy;
$ifilenum++;
}
move_uploaded_file($_FILES['CompanyCandidatePolicy']['tmp_name'], $uploadfilepolicy);
}
if (isset($_FILES['DisabilityCertificate'])) {
$uploaddisability = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['DisabilityCertificate']['name']))));
$uploadfiledisability = $uploaddir . $uploaddisability;
$ifilenum=1;
while (file_exists($uploadfiledisability) && !empty($uploaddisability)) {
$uploadfiledisability = $uploaddir . $ifilenum."_".$uploaddisability;
$ifilenum++;
}
move_uploaded_file($_FILES['DisabilityCertificate']['tmp_name'], $uploadfiledisability);
}
if (isset($_FILES['Payslip'])) {
$uploadpayslip = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['Payslip']['name']))));
$uploadfilepayslip = $uploaddir . $uploadpayslip;
$ifilenum=1;
while (file_exists($uploadfilepayslip) && !empty($uploadpayslip)) {
$uploadfilepayslip = $uploaddir . $ifilenum."_".$uploadpayslip;
$ifilenum++;
}
move_uploaded_file($_FILES['Payslip']['tmp_name'], $uploadfilepayslip);
}
if (isset($_FILES['BankAccountProof'])) {
$uploadbank = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['BankAccountProof']['name']))));
$uploadfilebank = $uploaddir . $uploadbank;
$ifilenum=1;
while (file_exists($uploadfilebank) && !empty($uploadbank)) {
$uploadfilebank = $uploaddir . $ifilenum."_".$uploadbank;
$ifilenum++;
}
move_uploaded_file($_FILES['BankAccountProof']['tmp_name'], $uploadfilebank);
}
if (isset($_FILES['Photograph'])) {
$uploadphoto = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['Photograph']['name']))));
$uploadfilephoto = $uploaddir . $uploadphoto;
$ifilenum=1;
while (file_exists($uploadfilephoto) && !empty($uploadphoto)) {
$uploadfilephoto = $uploaddir . $ifilenum."_".$uploadphoto;
$ifilenum++;
}
move_uploaded_file($_FILES['Photograph']['tmp_name'], $uploadfilephoto);
}
$sql = "INSERT INTO `CCMStudents` (`Organisation`, `Title`, `FirstName`, `Surname`, `KnownAs`, `JobTitle`, `Department`,
`IDNumber`, `DateofBirth`, `PlaceofBirth`, `CountryofBirth`, `MaleorFemale`, `RaceGroup`, `Disability`, `DisabilityNature`,
`ProfessionalCouncil`, `CategoryReg`, `CouncilRegNumber`, `LengthCandidateReg`, `YearsToProfReg`,
`FirstJobStart`, `VolAssociations`, `AreaDiscipline`, `AreaSubDiscipline`, `Telephone`, `Cellphone`, `EmailAddress`,
`WorkAddress`, `PostalAddress`, `VATNo`, `Salary`, `BankAccountName`, `BankAccountBank`, `BankAccountBranch`,
`BankAccountNo`, `Funding`, `CWDTP`, `MentorName`, `MentorDesig`, `MentorProfRegNo`, `MentorRegNo`,
`MentorTel`, `MentorCell`, `MentorEmail`, `SupervisorName`, `SupervisorDesig`, `SupervisorProfRegNo`, `SupervisorTelNo`,
`SupervisorCellNo`, `SupervisorEmail`, `HRManagerName`, `HRManagerDesignation`, `HRManagerTelNo`, `HRManagerCellNo`,
`HRManagerEmail`, `BookedByName`, `BookedByDesignation`, `BookedByTelNo`, `BookedByFaxNo`, `BookedByCellNo`, `BookedByEmail`,
`EducationalInst`, `Qualifications`, `DateFinalExam`, `BelongsTo`, `CESA_SABTACO_MemNum`, `IDFile`, `CVFile`, `QualCertificate1`, `QualCertificate2`, `QualCertificate3`,
`MentorUndertaking`, `CandUUndertaking`, `CompanyCandidatePolicy`, `DisabilityCertificate`, `Payslip`, `BankAccountProof`, `Photograph`)
VALUES ('".addslashes(stripslashes($_POST['Organisation']))."', '".addslashes(stripslashes($_POST['Title']))."', '".addslashes(stripslashes($_POST['FirstName']))."', '".addslashes(stripslashes($_POST['Surname']))."', '".addslashes(stripslashes($_POST['KnownAs']))."', '".addslashes(stripslashes($_POST['JobTitle']))."', '".addslashes(stripslashes($_POST['Department']))."', '".addslashes(stripslashes($_POST['IDNumber']))."', '".addslashes(stripslashes($_POST['DateofBirth']))."', '".addslashes(stripslashes($_POST['PlaceofBirth']))."', '".addslashes(stripslashes($_POST['CountryofBirth']))."', '".addslashes(stripslashes($_POST['MaleorFemale']))."', '".addslashes(stripslashes($_POST['RaceGroup']))."', '".addslashes(stripslashes($_POST['Disability']))."', '".addslashes(stripslashes($_POST['DisabilityNature']))."', '".addslashes(stripslashes($_POST['ProfessionalCouncil']))."', '".addslashes(stripslashes($_POST['CategoryReg']))."', '".addslashes(stripslashes($_POST['CouncilRegNumber']))."', '".addslashes(stripslashes($_POST['LengthCandidateReg']))."', '".addslashes(stripslashes($_POST['YearsToProfReg']))."', '".addslashes(stripslashes($_POST['FirstJobStart']))."', '".addslashes(stripslashes($_POST['VolAssociations']))."', '".addslashes(stripslashes($_POST['AreaDiscipline']))."', '".addslashes(stripslashes($_POST['AreaSubDiscipline']))."', '".addslashes(stripslashes($_POST['Telephone']))."', '".addslashes(stripslashes($_POST['Cellphone']))."', '".addslashes(stripslashes($_POST['EmailAddress']))."', '".addslashes(stripslashes($_POST['WorkAddress']))."', '".addslashes(stripslashes($_POST['PostalAddress']))."', '".addslashes(stripslashes($_POST['VATNo']))."', '".addslashes(stripslashes($_POST['Salary']))."', '".addslashes(stripslashes($_POST['BankAccountName']))."', '".addslashes(stripslashes($_POST['BankAccountBank']))."', '".addslashes(stripslashes($_POST['BankAccountBranch']))."', '".addslashes(stripslashes($_POST['BankAccountNo']))."', '".addslashes(stripslashes($_POST['Funding']))."', '".addslashes(stripslashes($_POST['CWDTP']))."', '".addslashes(stripslashes($_POST['MentorName']))."', '".addslashes(stripslashes($_POST['MentorDesig']))."', '".addslashes(stripslashes($_POST['MentorProfRegNo']))."', '".addslashes(stripslashes($_POST['MentorRegNo']))."', '".addslashes(stripslashes($_POST['MentorTel']))."', '".addslashes(stripslashes($_POST['MentorCell']))."', '".addslashes(stripslashes($_POST['MentorEmail']))."', '".addslashes(stripslashes($_POST['SupervisorName']))."', '".addslashes(stripslashes($_POST['SupervisorDesig']))."', '".addslashes(stripslashes($_POST['SupervisorProfRegNo']))."', '".addslashes(stripslashes($_POST['SupervisorTelNo']))."', '".addslashes(stripslashes($_POST['SupervisorCellNo']))."', '".addslashes(stripslashes($_POST['SupervisorEmail']))."', '".addslashes(stripslashes($_POST['HRManagerName']))."', '".addslashes(stripslashes($_POST['HRManagerDesignation']))."', '".addslashes(stripslashes($_POST['HRManagerTelNo']))."', '".addslashes(stripslashes($_POST['HRManagerCellNo']))."', '".addslashes(stripslashes($_POST['HRManagerEmail']))."', '".addslashes(stripslashes($_POST['BookedByName']))."', '".addslashes(stripslashes($_POST['BookedByDesignation']))."', '".addslashes(stripslashes($_POST['BookedByTelNo']))."', '".addslashes(stripslashes($_POST['BookedByFaxNo']))."', '".addslashes(stripslashes($_POST['BookedByCellNo']))."', '".addslashes(stripslashes($_POST['BookedByEmail']))."', '".addslashes(stripslashes($_POST['EducationalInst']))."', '".addslashes(stripslashes($_POST['Qualifications']))."', '".addslashes(stripslashes($_POST['DateFinalExam']))."', '".addslashes(stripslashes($_POST["belongsto"]))."', '".addslashes(stripslashes($_POST["cesamemnum"]))."',
'".str_replace($uploaddir, '', $uploadfileID)."',
'".str_replace($uploaddir, '', $uploadfileCV)."',
'".str_replace($uploaddir, '', $uploadfilequal1)."',
'".str_replace($uploaddir, '', $uploadfilequal2)."',
'".str_replace($uploaddir, '', $uploadfilequal3)."',
'".str_replace($uploaddir, '', $uploadfilementor)."',
'".str_replace($uploaddir, '', $uploadfilecandu)."',
'".str_replace($uploaddir, '', $uploadfilepolicy)."',
'".str_replace($uploaddir, '', $uploadfiledisability)."',
'".str_replace($uploaddir, '', $uploadfilepayslip)."',
'".str_replace($uploaddir, '', $uploadfilebank)."',
'".str_replace($uploaddir, '', $uploadfilephoto)."')";
//echo $sql;
mysql_query($sql);
$iStudentID = mysql_insert_id();
$sStudentNumber = "CCM".str_pad($iStudentID, 6, "0", STR_PAD_LEFT);
$WebUsername = $sStudentNumber;
$WebPassword = GenPassword();
$sql = "UPDATE CCMStudents SET StudentNumber='".$sStudentNumber."', WebUsername='".$WebUsername."', WebPassword='".$WebPassword."'
WHERE CCMStudentID=".$iStudentID;
mysql_query($sql);
$sForm = '
<table width="643" border="1" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td valign="top">Organisation:</td>
<td>'.$_REQUEST["Organisation"].'</td>
</tr>
<tr>
<td>Title:</td>
<td>'.$_REQUEST["Title"].'
</td>
</tr>
<tr>
<td width="298"><p>First Name:</p></td>
<td width="319">'.$_REQUEST["FirstName"].'</td>
</tr>
<tr>
<td><p>Surname:</p></td>
<td>'.$_REQUEST["Surname"].'</td>
</tr>
<tr>
<td><p>Preferred Name (Known As):</p></td>
<td>'.$_REQUEST["KnownAs"].'</td>
</tr>
<tr>
<td>Job Title:</td>
<td>'.$_REQUEST["JobTitle"].'</td>
</tr>
<tr>
<td>Department:</td>
<td>'.$_REQUEST["Department"].'</td>
</tr>
<tr>
<td>South African ID Number (Only):</td>
<td>'.$_REQUEST["IDNumber"].'</td>
</tr>
<tr>
<td>Date of Birth:</td>
<td>'.$_REQUEST["DateofBirth"].'</td>
</tr>
<tr>
<td>Place of Birth:</td>
<td>'.$_REQUEST["PlaceofBirth"].'</td>
</tr>
<tr>
<td>Country of Birth:</td>
<td>'.$_REQUEST["CountryofBirth"].'</td>
</tr>
<tr>
<td>Male / Female:</td>
<td>'.$_REQUEST["MaleorFemale"].'</td>
</tr>
<tr>
<td>Race Group:</td>
<td>'.$_REQUEST["RaceGroup"].'</td>
</tr>
<tr>
<td>Do you have a disability?</td>
<td>'.$_REQUEST["Disability"].'</td>
</tr>
<tr>
<td>If so, indicate the nature:</td>
<td>'.$_REQUEST["DisabilityNature"].'</td>
</tr>
<tr>
<td>With which professional council are you registered?</td>
<td>'.$_REQUEST["ProfessionalCouncil"].'</td>
</tr>
<tr>
<td>Category of registration:</td>
<td>'.$_REQUEST["CategoryReg"].'</td>
</tr>
<tr>
<td>Council registration number (if applicable):</td>
<td>'.$_REQUEST["CouncilRegNumber"].'</td>
</tr>
<tr>
<td>How long have you been registered as a candidate?</td>
<td>'.$_REQUEST["LengthCandidateReg"].'</td>
</tr>
<tr>
<td>How many years left to professional registration?</td>
<td>'.$_REQUEST["YearsToProfReg"].'</td>
</tr>
<tr>
<td>Start date of first job post qualification:</td>
<td>'.$_REQUEST["FirstJobStart"].'</td>
</tr>
<tr>
<td>Membership of voluntary associations:</td>
<td>'.$_REQUEST["VolAssociations"].'</td>
</tr>
<tr>
<td>Belongs to:</td>
<td>'.$_REQUEST["belongsto"].'</td>
</tr>
<tr>
<td>CESA / SABTACO membership number:</td>
<td>'.$_REQUEST["cesamemnum"].'</td>
</tr>
<tr>
<td>Area of Discipline:</td>
<td>'.$_REQUEST["AreaDiscipline"].'</td>
</tr>
<!-- <tr>
<td>Area of Sub-discipline:</td>
<td>'.$_REQUEST["AreaSubDiscipline"].'</td>
</tr> -->
<tr>
<td><p>Telephone No:</p></td>
<td>'.$_REQUEST["Telephone"].'</td>
</p></td>
</tr>
<tr>
<td><p>Cell No. :</p></td>
<td>'.$_REQUEST["Cellphone"].'</td>
</tr>
<tr>
<td><p>E-mail Address:</p></td>
<td>'.$_REQUEST["EmailAddress"].'</td>
</tr>
<tr>
<td valign="top">Work Physical Address:</td>
<td>'.stripslashes($_REQUEST["WorkAddress"]).'</td>
</tr>
<tr>
<td valign="top">Province:</td>
<td>'.$_REQUEST["Province"].'</td>
</tr>
<!-- <tr>
<td valign="top">Postal Address:</td>
<td>'.stripslashes($_REQUEST["PostalAddress"]).'</td>
</tr>
<tr>
<td valign="top">VAT No:</td>
<td>'.$_REQUEST["VATNo"].'</td>
</tr>
<tr>
<td valign="top">Salary (Basic):</td>
<td>'.$_REQUEST["Salary"].'</td>
</tr>
<tr>
<td valign="top">Bank account details:</td>
<td align="right">Name: '.$_REQUEST["BankAccountName"].'<br />Bank: '.$_REQUEST["BankAccountBank"].'<br />
Branch: '.$_REQUEST["BankAccountBranch"].'<br />
Number: '.$_REQUEST["BankAccountNo"].'</td>
</tr> -->
<tr>
<td valign="top">Do you have funding from any other skills development programme/project funded by a public institution? (Describe)</td>
<td>'.$_REQUEST["Funding"].'</td>
</tr>
<!-- <tr>
<td valign="top">Does your company have a structured Candidate Workplace Development/ Training Plan?</td>
<td>'.$_REQUEST["CWDTP"].'</td>
</tr> -->
<tr>
<td valign="top"><strong>Mentor:</strong></td>
<td>'.$_REQUEST["MentorName"].'</td>
</tr>
<!-- <tr>
<td valign="top">Designation:</td>
<td>'.$_REQUEST["MentorDesig"].'</td>
</tr>
<tr>
<td valign="top">Professional Registration No:</td>
<td>'.$_REQUEST["MentorProfRegNo"].'</td>
</tr>
<tr>
<td valign="top">Mentor\'s Registration No:</td>
<td>'.$_REQUEST["MentorRegNo"].'</td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td>'.$_REQUEST["MentorTel"].'</td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td>'.$_REQUEST["MentorCell"].'</td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td>'.$_REQUEST["MentorEmail"].'</td>
</tr>
-->
<tr>
<td valign="top"><strong>Supervisor:</strong></td>
<td>'.$_REQUEST["SupervisorName"].'</td>
</tr>
<!--
<tr>
<td valign="top">Designation:</td>
<td>'.$_REQUEST["SupervisorDesig"].'</td>
</tr>
<tr>
<td valign="top">Professional Registration No: (if applicable)</td>
<td>'.$_REQUEST["SupervisorProfRegNo"].'</td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td>'.$_REQUEST["SupervisorTelNo"].'</td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td>'.$_REQUEST["SupervisorCellNo"].'</td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td>'.$_REQUEST["SupervisorEmail"].'</td>
</tr>
<tr>
<td valign="top"><strong>HR Manager:</strong></td>
<td>'.$_REQUEST["HRManagerName"].'</td>
</tr>
<tr>
<td valign="top">Designation:</td>
<td>'.$_REQUEST["HRManagerDesignation"].'</td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td>'.$_REQUEST["HRManagerTelNo"].'</td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td>'.$_REQUEST["HRManagerCellNo"].'</td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td>'.$_REQUEST["HRManagerEmail"].'</td>
</tr>
-->
<tr>
<td valign="top"><strong>Application Loaded By:</strong></td>
<td>'.$_REQUEST["BookedByName"].'</td>
</tr>
<!-- <tr>
<td valign="top">Designation:</td>
<td>'.$_REQUEST["BookedByDesignation"].'</td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td>'.$_REQUEST["BookedByTelNo"].'</td>
</tr>
<tr>
<td valign="top">Fax No:</td>
<td>'.$_REQUEST["BookedByFaxNo"].'</td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td>'.$_REQUEST["BookedByCellNo"].'</td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td>'.$_REQUEST["BookedByEmail"].'</td>
</tr>
<tr>
<td valign="top"><strong>South African - Highest Examinations Passed:</strong></td>
<td> </td>
</tr>
<tr>
<td valign="top">Educational Institution:</td>
<td>'.$_REQUEST["EducationalInst"].'<br/>'.$_REQUEST["EducationInstOther"].'</td>
</tr> -->
<tr>
<td valign="top">Qualifications Attained:</td>
<td>'.$_REQUEST["Qualifications"].'</td>
</tr>
<tr>
<td valign="top">Date of Final Examination:</td>
<td>'.$_REQUEST["DateFinalExam"].'</td>
</tr>
<!-- <tr>
<td valign="top"><strong>Documents:</strong></td>
<td> </td>
</tr>
<tr>
<td valign="top">Certified copy of ID or passport:</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfileID).'">'.str_replace($uploaddir, '', $uploadfileID).'</a></td>
</tr>
<tr>
<td valign="top">Curriculum Vitae (CV):</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfileCV).'">'.str_replace($uploaddir, '', $uploadfileCV).'</a></td>
</tr>
<tr>
<td valign="top">Certified copies of qualification/s:</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilequal1).'">'.str_replace($uploaddir, '', $uploadfilequal1).'</a><br>
<a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilequal2).'">'.str_replace($uploaddir, '', $uploadfilequal2).'</a><br />
<a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilequal3).'">'.str_replace($uploaddir, '', $uploadfilequal3).'</a></td>
</tr>
<tr>
<td valign="top">Undertaking from Mentor:</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilementor).'">'.str_replace($uploaddir, '', $uploadfilementor).'</a></td>
</tr>
<tr>
<td valign="top">Undertaking of C&U (ECSA):</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilecandu).'">'.str_replace($uploaddir, '', $uploadfilecandu).'</a></td>
</tr>
<tr>
<td valign="top">Employment contract:</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilepolicy).'">'.str_replace($uploaddir, '', $uploadfilepolicy).'</a></td>
</tr>
<tr>
<td valign="top">Cerificate of disability (if applicable):</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfiledisability).'">'.str_replace($uploaddir, '', $uploadfiledisability).'</a></td>
</tr>
<tr>
<td valign="top">Payslip:</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilepayslip).'">'.str_replace($uploaddir, '', $uploadfilepayslip).'</a></td>
</tr>
<tr>
<td valign="top">Proof of bank account (candidate, not company):</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilebank).'">'.str_replace($uploaddir, '', $uploadfilebank).'</a></td>
</tr>
<tr>
<td valign="top">Photograph:</td>
<td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilephoto).'">'.str_replace($uploaddir, '', $uploadfilephoto).'</a></td>
</tr> -->
</tbody>
</table>
';
// To send HTML mail, the Content-type header must be set
$headers = 'MIME-Version: 1.0' . "\r\n";
$headers .= 'Content-type: text/html; charset=iso-8859-1' . "\r\n";
// Additional headers
$headers .= 'From: '.$_REQUEST["EmailAddress"] . "\r\n";
$headers .= 'BCC: julia@xe.co.za' . "\r\n";
// $headers .= 'CC: athromethm@cesa.co.za' . "\r\n";
$sSendFormTo = "mentanet@cesa.co.za";
// $sSendFormTo = "julia@xe.co.za";
mail($sSendFormTo, "REGISTRATION FOR SABTACO/CESA Candidacy Programme", $sForm, $headers);
?>
<p><strong>Thank you for completing the ‘Expression of Interest’ application form, for the SABTACO/CESA Candidacy Programme, to develop Graduates/Candidates towards professional registration in a range of Built Environment categories.</strong></p>
<p>Only completed application forms, with all supporting documentation, except for the Graduate/ Candidate’s training plan, if not available at time of submitting, will be considered.</p>
<p><strong>DISCLAIMER:</strong></p>
<ul>
<li>This request to submit an EOI is not an agreement and is not an offer or invitation to enter into an agreement of any kind with any party.</li>
<li>All information contained in this Expression of Interest (EOI) or subsequently provided is done so in good faith.</li>
<li>CESA and SABTACO reserve the right to accept/reject any Expression of Interest (EOI) from parties without assigning any reasons whatsoever.</li>
</ul>
<p>Please email <a href="mailto:mentanet@cesa.co.za">mentanet@cesa.co.za</a> if you have any questions. A copy of your form appears below.</p>
<p><strong><a href="register.php">Click here to register another candidate</a></strong></p>
<hr />
<?php echo $sForm; ?>
<?php
}
}
}
if ($bShowForm) {
?>
<form action="/mentanet/register.php" method="post" enctype="multipart/form-data" name="form1" id="form1">
<input type="hidden" name="go" value="1" />
<h3>APPLICATION FORM: CETA Candidacy Programmes to Culminate in the Registration of Candidates in Designated Professions</h3>
<p>
<?php
if (!empty($sMsg)) echo "<p style='color:red'><b>Error:<br /><ul style='color:red'>".$sMsg."</ul></b></p>";
?>
</p>
<p>During 2013-2014 the SABTACO/CESA Partnership has been awarded funding from the Construction Education and Training Authority (CETA) to support their member organisations in structuring their candidacy programmes. The funding has now been extended for another year with the opportunity to admit new candidates to the existing group.</p>
<p>This serves as an invitation to CESA and SABTACO members to send in an Expression of Interest to provide structured workplace training towards professional registration in the following categories:</p>
<p>Candidate Engineers<br>
Candidate Technologists<br>
Candidate Planners<br>
Candidate Architects</p>
<p><strong>WHO QUALIFIES?</strong></p>
<p>Graduates/candidates:</p>
<ul>
<li>In full time or contract employment in a company with up to date CESA and/or SABTACO membership or who are individual members of SABTACO.</li>
<li>Earning more than R2 500.00 per month and have a bank account into which their salaries are being paid (verifiable by payslips).</li>
<li>Who have completed a Bachelor/BTech degree/National Diploma recognised for professional registration in the categories listed above.</li>
<li>With 3 years working experience.</li>
<li>Who are South African citizens. </li>
</ul>
<p>All online applications received by the deadline (1 September 2014) and who meet the eligibility requirements will be reviewed as a potential candidate for the programme.<br>
Successful applicants will receive a letter of confirmation as well as a Candidacy Agreement to sign specifying details and conditions.</p>
<p><strong>WHAT IS EXPECTED OF THE EMPLOYER?</strong></p>
<p><strong>The employer should:</strong></p>
<ul>
<li>Ensure that the graduates register as candidates in the appropriate categories.</li>
<li>Provide structured training and experience against council competencies standards. </li>
<li>Provide a variety of activities over the training and experience period (including rotation/secondment where necessary).</li>
<li>Ensure that the candidates’ level of responsibility increase over time.</li>
<li>Ensure that candidates document evidence on the MentAnet of planning, recording, reporting and assessment per milestone.</li>
<li>Allocate professionally registered supervisors per projects to take responsibility for the work in terms.</li>
<li>Allocate/appoint professionally registered internal or external Mentors (preferably for the duration of the candidacy programme to ensure continuity)</li>
<li>Maintain a register of mentors and candidates and update any changes.</li>
<li>Provide mentors with training and mentoring guidelines.</li>
<li>Provide supplementary training for the candidates as required per milestone.</li>
<li>Assess the candidates’ progress on an ongoing basis by supervisors and mentors.</li>
<li>Support and encourage mentors to equip themselves to be effective mentors.</li>
<li>Create the opportunity and an environment conducive to effective liaison between Candidates and their Mentors.</li>
<li>Submit signed Candidacy Agreements.</li>
</ul>
<p><strong>CESA/SABTACO UNDERTAKING: </strong></p>
<ul>
<li>Each candidate’s firm/individual will be allocated R40 000.00 per candidate/year and will be paid according to mandatory deliverables submitted per milestone via the CESA MentAnet. The above funding may be used for subvention of the candidate’s salary, supplementary courses towards up-skilling the candidate external mentoring or covering existing candidacy programme costs.</li>
<li>All data, knowledge and documents communicated will be treated in the strictest confidence. </li>
</ul>
<p><strong>HOW TO APPLY:</strong></p>
<p>Member firm/individual’s organisation must:</p>
<ul>
<li> Complete the online EOI form on behalf of each graduate/candidate.<br>
Please either save or print as proof of submission. </li>
<li>If selected, all supporting documentation - original signed application form, proof of residence, proof of bank account (bank stamped confirmation letter) and ID size photo; certified copies (with original stamp) of qualifications, ID, payslips and contract of employment will be required to be posted to:</li>
</ul>
<p><em>SABTACO National Office</em><br>
<em>9th Floor, 87 De Korte Street</em><br>
<em>Braamfontein, 2017</em></p>
<p><strong><em>The deadline for submissions is 1st September 2014</em></strong> <br>
For enquires contact Thamary Jani on <a href="mailto:mentanet@cesa.co.za">mentanet@cesa.co.za</a> or (011) 403 2165 </p>
<p><strong>DISBURSEMENT PROCEDURE</strong><strong> </strong><br>
The disbursement will (only) be paid by EFT directly to the employer’s bank account, at regular intervals, once milestones and periodic reports have been received, verified and related funding received by the CETA. </p>
<p><strong>DISCLAIMER:</strong></p>
<ul>
<li><strong><em>This request to submit an EOI is not an agreement and is not an offer or invitation to enter into an agreement of any kind with any party. </em></strong></li>
<li>All information contained in this Expression of Interest (EOI) or subsequently provided is done so in good faith. </li>
<li>CESA and SABTACO reserve the right to accept/reject any Expression of Interest (EOI) from parties without assigning any reasons whatsoever. </li>
</ul>
<p><strong>Please complete the on-line application form for each candidate below.</strong></p>
<table width="643" border="1" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td valign="top">Organisation:</td>
<td><input name="Organisation" type="text" id="Organisation" size="50" value="<?php echo $_REQUEST["Organisation"]; ?>" /></td>
</tr>
<tr>
<td>Title:</td>
<td>
<select name="Title" id="Title">
<?php
$arr=array('Mr', 'Mrs', 'Ms', 'Miss', 'Dr', 'Prof');
WriteOptions("Title", $arr);
?>
</select>
</td>
</tr>
<tr>
<td width="298"><p>First Name:</p></td>
<td width="319"><p>
<input name="FirstName" type="text" id="FirstName" size="50" value="<?php echo $_REQUEST["FirstName"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>Surname:</p></td>
<td><input name="Surname" type="text" id="Surname" size="50" value="<?php echo $_REQUEST["Surname"]; ?>" /></td>
</tr>
<tr>
<td><p>Preferred Name (Known As):</p></td>
<td><p>
<input name="KnownAs" type="text" id="KnownAs" size="50" value="<?php echo $_REQUEST["KnownAs"]; ?>" />
</p></td>
</tr>
<tr>
<td>Job Title:</td>
<td><input name="JobTitle" type="text" id="Designation" size="50" value="<?php echo $_REQUEST["JobTitle"]; ?>" /></td>
</tr>
<tr>
<td>Department:</td>
<td><input name="Department" type="text" id="Designation2" size="50" value="<?php echo $_REQUEST["Department"]; ?>" /></td>
</tr>
<tr>
<td>South African ID Number (Only):</td>
<td><input name="IDNumber" type="text" id="IDNumber" size="30" value="<?php echo $_REQUEST["IDNumber"]; ?>" /></td>
</tr>
<tr>
<td>Date of Birth:</td>
<td><input name="DateofBirth" type="text" id="DateofBirth" size="30" value="<?php echo $_REQUEST["DateofBirth"]; ?>" /></td>
</tr>
<tr>
<td>Place of Birth:</td>
<td><label for="PlaceofBirth"></label>
<select name="PlaceofBirth" id="PlaceofBirth">
<option value=""></option>
<optgroup label="Eastern Cape">
<?php
$arr=array('Addo', 'Aliwal North', 'Cape St Francis', 'Cradock', 'East London', 'Graaff-Reinet', 'Grahamstown', 'Humansdorp', 'Jeffreys Bay ', 'Kenton-on-Sea', 'Middleburg', 'Nieu Bethesda', 'Oyster Bay', 'Port Alfred', 'Port Elizabeth', 'Rhodes ', 'Shelley Beach', 'Somerset East', 'St Francis Bay');
WriteOptions("PlaceofBirth", $arr);
?>
</optgroup>
<optgroup label="Free State">
<?php
$arr=array('Bethlehem', 'Bloemfontein', 'Clarens', 'Ficksburg', 'Fouriesburg', 'Gariep Dam', 'Golden Gate', 'Harrismith', 'Heilbron', 'Kestell', 'Kroonstad', 'Ladybrand', 'Lindley', 'Parys', 'Qwa Qwa', 'Villiers', 'Warden', 'Winburg');
WriteOptions("PlaceofBirth", $arr);
?>
</optgroup>
<optgroup label="Gauteng">
<option>Alberton</option>
<option>Benoni</option>
<option>Bronkhorstspruit</option>
<option>Carletonville</option>
<option>Centurion</option>
<option>Cullinan</option>
<option>Germiston</option>
<option>Heidelberg</option>
<option>Johannesburg</option>
<option>Kempton Park</option>
<option>Krugersdorp</option>
<option>KwaMhlanga </option>
<option>Midrand</option>
<option>Muldersdrift</option>
<option>Nigel</option>
<option>Pretoria</option>
<option>Randburg </option>
<option>Roodepoort</option>
<option>Sandton</option>
<option>Saxonworld</option>
<option>Soweto</option>
<option>Springs</option>
<option>Temba</option>
<option>Vanderbijlpark</option>
<option>Vereeniging</option>
</optgroup>
<optgroup label="KwaZulu-Natal">
<option>Amanzimtoti</option>
<option>Babanago</option>
<option>Babanango</option>
<option>Ballito</option>
<option>Bergville</option>
<option>Blythedale Beach</option>
<option>Boston-Bulwer</option>
<option>Colenso</option>
<option>Dundee</option>
<option>Durban</option>
<option>Empangeni</option>
<option>Eshowe</option>
<option>Estcourt</option>
<option>Gingindlovu</option>
<option>Glencoe</option>
<option>Greytown</option>
<option>Harding</option>
<option>Hibberdene</option>
<option>Himeville</option>
<option>Hluhluwe</option>
<option>Howick</option>
<option>Ixopo</option>
<option>Jozini</option>
<option>Karkloof</option>
<option>Kokstad</option>
<option>Kosi Bay</option>
<option>Kranskop</option>
<option>Ladysmith</option>
<option>Magudu</option>
<option>Margate</option>
<option>Matatiele</option>
<option>Melmoth</option>
<option>Mkuze</option>
<option>Mooi River</option>
<option>Morningside & Berea Area</option>
<option>Mtubatuba</option>
<option>Mtunzini</option>
<option>Newcastle</option>
<option>Nongoma</option>
<option>Nottingham Road</option>
<option>Nquthu</option>
<option>Oribi Flats</option>
<option>Paulpietersburg</option>
<option>Pennington</option>
<option>Pietermaritzburg</option>
<option>Pongola</option>
<option>Port Edward</option>
<option>Port Shepstone</option>
<option>Richards Bay</option>
<option>Richmond-Bryne</option>
<option>Rosetta</option>
<option>Salt Rock</option>
<option>Scottburgh</option>
<option>Shaka's Kraal</option>
<option>Shaka's Rock</option>
<option>Sheffield Beach</option>
<option>Sodwana Bay</option>
<option>Southbroom</option>
<option>St Lucia</option>
<option>Stanger</option>
<option>Sugar Coast</option>
<option>Swartberg</option>
<option>Tinley Manor</option>
<option>Township Area's</option>
<option>Ulundi</option>
<option>Umhlanga, Umdloti etc.</option>
<option>Umkomaas</option>
<option>Underberg</option>
<option>Utrecht</option>
<option>Valley of 1000 Hills</option>
<option>Volksrust</option>
<option>Vryheid</option>
<option>Wartburg</option>
<option>Weenen</option>
<option>Winterton</option>
<option>Zimbali</option>
<option>Zinkwazi</option>
</optgroup>
<optgroup label="Limpopo">
<option>Ellisras</option>
<option>Hoedspruit</option>
<option>Kruger National Park</option>
<option>Louis Trichardt</option>
<option>Melkrivier</option>
<option>Messina</option>
<option>Naboomspruit</option>
<option>Nylstroom</option>
<option>Phalaborwa</option>
<option>Pietersburg</option>
<option>Port Nolloth </option>
<option>Potgietersrus </option>
<option>Queenstown</option>
<option>Rust de Winter</option>
<option>Thabazimbi</option>
<option>Tzaneen</option>
<option>Vaalwater</option>
<option>Warm Baths</option>
</optgroup>
<optgroup label="Mpumalanga">
<option>Badplaas</option>
<option>Barberton</option>
<option>Bethal</option>
<option>Blyde River Canyon</option>
<option>Dullstroom</option>
<option>Ermelo</option>
<option>Graskop</option>
<option>Groblersdal</option>
<option>Hazyview</option>
<option>Hoedspruit</option>
<option>Kaapschehoop</option>
<option>Kruger National Park</option>
<option>Lydenburg</option>
<option>Malelane</option>
<option>Marloth Park Game Reserve</option>
<option>Middelburg</option>
<option>Nelspruit</option>
<option>Piet Retief</option>
<option>Pilgrims Rest</option>
<option>Sabie</option>
<option>Skukuza</option>
<option>Standerton</option>
<option>Volksrust</option>
<option>Wakkerstroom</option>
<option>Waterval Boven </option>
<option>White River</option>
<option>Witbank</option>
</optgroup>
<optgroup label="North West">
<option>Bloemhof</option>
<option>Brits</option>
<option>Carolina</option>
<option>Christiana</option>
<option>Groot Marico</option>
<option>Hartbeespoort Dam</option>
<option>Klerksdorp</option>
<option>Lichtenburg</option>
<option>Madikwe</option>
<option>Mafikeng</option>
<option>Magaliesberg</option>
<option>Mmabatho</option>
<option>Pilansberg</option>
<option>Potchefstroom</option>
<option>Rustenberg</option>
<option>Tosca</option>
<option>Vryburg</option>
<option>Zeerust</option>
</optgroup>
<optgroup label="Northern Cape">
<option>Barkly West</option>
<option>Britstown</option>
<option>Colesberg</option>
<option>Garies</option>
<option>Groblershoop</option>
<option>Hanover Kalahari</option>
<option>Kakamas</option>
<option>Kanoneiland</option>
<option>Kimberley</option>
<option>Kuruman</option>
<option>Orania</option>
<option>Port Nolloth</option>
<option>Richmond</option>
<option>Springbok</option>
<option>Upington </option>
<option>Vioolsdrift</option>
</optgroup>
<optgroup label="Western Cape">
<option>Agulhas</option>
<option>Albertinia</option>
<option>Arniston</option>
<option>Ashton</option>
<option>Aurora</option>
<option>Barrydale</option>
<option>Beaufort West</option>
<option>Betty's Bay</option>
<option>Bitterfontein</option>
<option>Bonnievale</option>
<option>Brakenfell</option>
<option>Bredasdorp</option>
<option>Caledon</option>
<option>Calitzdorp</option>
<option>Cape Town</option>
<option>Carnarvon</option>
<option>Ceres</option>
<option>Citrusdal</option>
<option>Clanwilliam</option>
<option>Darling</option>
<option>De Doorns</option>
<option>De Kelders</option>
<option>De Rust</option>
<option>Doring Bay</option>
<option>Dwarskersbos</option>
<option>Elands Bay</option>
<option>Elim</option>
<option>Franschhoek</option>
<option>Gansbaai</option>
<option>Garden Route</option>
<option>George</option>
<option>Gordon's Bay</option>
<option>Grabouw </option>
<option>Greyton</option>
<option>Harkerville</option>
<option>Hermanus</option>
<option>Hopefield </option>
<option>Jacobs Bay</option>
<option>Jonkershoek</option>
<option>Kamieskroon</option>
<option>Kleinmond</option>
<option>Knysna</option>
<option>L'Agulhas</option>
<option>Ladismith</option>
<option>Laingsburg</option>
<option>Lamberts Bay</option>
<option>Langebaan</option>
<option>Leliefontein</option>
<option>Little Karoo</option>
<option>Loeriesfontein</option>
<option>Lutzville</option>
<option>McGregor</option>
<option>Montagu</option>
<option>Mossel Bay</option>
<option>Nature's Valley</option>
<option>Oudtshoorn</option>
<option>Paarl</option>
<option>Paternoster</option>
<option>Piketberg</option>
<option>Plettenberg Bay</option>
<option>Porterville</option>
<option>Porteville</option>
<option>Prince Albert</option>
<option>Prince Alfred Hamlet</option>
<option>Rawsonville</option>
<option>Riebeeck Kasteel</option>
<option>Riebeeck West</option>
<option>Riversdale</option>
<option>Robertson</option>
<option>Rooi Els</option>
<option>Saldanha</option>
<option>Sedgefield</option>
<option>Simonstown</option>
<option>Somerset West</option>
<option>St Helena Bay</option>
<option>Stellenbosch</option>
<option>Still Bay</option>
<option>Stormsriver</option>
<option>Strand</option>
<option>Strandfontein</option>
<option>Struisbaai</option>
<option>Sutherland</option>
<option>Swellendam</option>
<option>Touws River</option>
<option>Tulbagh</option>
<option>Uniondale</option>
<option>Vanrhynsdorp</option>
<option>Velddrif</option>
<option>Vredenburg</option>
<option>Vredendal</option>
<option>Wellington</option>
<option>West Coast</option>
<option>Wilderness</option>
<option>Winelands</option>
<option>Witsand</option>
<option>Worcester</option>
<option>Wuppertal</option>
<option>Yzerfontein</option>
<option>Zoar</option>
</optgroup>
</select></td>
</tr>
<tr>
<td>Country of Birth:</td>
<td><select name="CountryofBirth" id="CountryofBirth">
<option value=""></option>
<option>Afghanistan</option>
<option>Akrotiri</option>
<option>Albania</option>
<option>Algeria</option>
<option>American Samoa</option>
<option>Andorra</option>
<option>Angola</option>
<option>Anguilla</option>
<option>Antarctica</option>
<option>Antigua and Barbuda</option>
<option>Argentina</option>
<option>Armenia</option>
<option>Aruba</option>
<option>Ashmore and Cartier Islands</option>
<option>Australia</option>
<option>Austria</option>
<option>Azerbaijan</option>
<option>Bahamas, The</option>
<option>Bahrain</option>
<option>Bangladesh</option>
<option>Barbados</option>
<option>Bassas da India</option>
<option>Belarus</option>
<option>Belgium</option>
<option>Belize</option>
<option>Benin</option>
<option>Bermuda</option>
<option>Bhutan</option>
<option>Bolivia</option>
<option>Bosnia and Herzegovina</option>
<option>Botswana</option>
<option>Bouvet Island</option>
<option>Brazil</option>
<option>British Indian Ocean Territory</option>
<option>British Virgin Islands</option>
<option>Brunei</option>
<option>Bulgaria</option>
<option>Burkina Faso</option>
<option>Burma</option>
<option>Burundi</option>
<option>Cambodia</option>
<option>Cameroon</option>
<option>Canada</option>
<option>Cape Verde</option>
<option>Cayman Islands</option>
<option>Central African Republic</option>
<option>Chad</option>
<option>Chile</option>
<option>China</option>
<option>Christmas Island</option>
<option>Clipperton Island</option>
<option>Cocos (Keeling) Islands</option>
<option>Colombia</option>
<option>Comoros</option>
<option>Congo, Democratic Republic of the</option>
<option>Congo, Republic of the</option>
<option>Cook Islands</option>
<option>Coral Sea Islands</option>
<option>Costa Rica</option>
<option>Cote d'Ivoire</option>
<option>Croatia</option>
<option>Cuba</option>
<option>Cyprus</option>
<option>Czech Republic</option>
<option>Denmark</option>
<option>Dhekelia</option>
<option>Djibouti</option>
<option>Dominica</option>
<option>Dominican Republic</option>
<option>Ecuador</option>
<option>Egypt</option>
<option>El Salvador</option>
<option>Equatorial Guinea</option>
<option>Eritrea</option>
<option>Estonia</option>
<option>Ethiopia</option>
<option>Europa Island</option>
<option>Falkland Islands (Islas Malvinas)</option>
<option>Faroe Islands</option>
<option>Fiji</option>
<option>Finland</option>
<option>France</option>
<option>French Guiana</option>
<option>French Polynesia</option>
<option>French Southern and Antarctic Lands</option>
<option>Gabon</option>
<option>Gambia, The</option>
<option>Gaza Strip</option>
<option>Georgia</option>
<option>Germany</option>
<option>Ghana</option>
<option>Gibraltar</option>
<option>Glorioso Islands</option>
<option>Greece</option>
<option>Greenland</option>
<option>Grenada</option>
<option>Guadeloupe</option>
<option>Guam</option>
<option>Guatemala</option>
<option>Guernsey</option>
<option>Guinea</option>
<option>Guinea-Bissau</option>
<option>Guyana</option>
<option>Haiti</option>
<option>Heard Island and McDonald Islands</option>
<option>Holy See (Vatican City)</option>
<option>Honduras</option>
<option>Hong Kong</option>
<option>Hungary</option>
<option>Iceland</option>
<option>India</option>
<option>Indonesia</option>
<option>Iran</option>
<option>Iraq</option>
<option>Ireland</option>
<option>Isle of Man</option>
<option>Israel</option>
<option>Italy</option>
<option>Jamaica</option>
<option>Jan Mayen</option>
<option>Japan</option>
<option>Jersey</option>
<option>Jordan</option>
<option>Juan de Nova Island</option>
<option>Kazakhstan</option>
<option>Kenya</option>
<option>Kiribati</option>
<option>Korea, North</option>
<option>Korea, South</option>
<option>Kuwait</option>
<option>Kyrgyzstan</option>
<option>Laos</option>
<option>Latvia</option>
<option>Lebanon</option>
<option>Lesotho</option>
<option>Liberia</option>
<option>Libya</option>
<option>Liechtenstein</option>
<option>Lithuania</option>
<option>Luxembourg</option>
<option>Macau</option>
<option>Macedonia</option>
<option>Madagascar</option>
<option>Malawi</option>
<option>Malaysia</option>
<option>Maldives</option>
<option>Mali</option>
<option>Malta</option>
<option>Marshall Islands</option>
<option>Martinique</option>
<option>Mauritania</option>
<option>Mauritius</option>
<option>Mayotte</option>
<option>Mexico</option>
<option>Micronesia, Federated States of</option>
<option>Moldova</option>
<option>Monaco</option>
<option>Mongolia</option>
<option>Montserrat</option>
<option>Morocco</option>
<option>Mozambique</option>
<option>Namibia</option>
<option>Nauru</option>
<option>Navassa Island</option>
<option>Nepal</option>
<option>Netherlands</option>
<option>Netherlands Antilles</option>
<option>New Caledonia</option>
<option>New Zealand</option>
<option>Nicaragua</option>
<option>Niger</option>
<option>Nigeria</option>
<option>Niue</option>
<option>Norfolk Island</option>
<option>Northern Mariana Islands</option>
<option>Norway</option>
<option>Oman</option>
<option>Pakistan</option>
<option>Palau</option>
<option>Panama</option>
<option>Papua New Guinea</option>
<option>Paracel Islands</option>
<option>Paraguay</option>
<option>Peru</option>
<option>Philippines</option>
<option>Pitcairn Islands</option>
<option>Poland</option>
<option>Portugal</option>
<option>Puerto Rico</option>
<option>Qatar</option>
<option>Reunion</option>
<option>Romania</option>
<option>Russia</option>
<option>Rwanda</option>
<option>Saint Helena</option>
<option>Saint Kitts and Nevis</option>
<option>Saint Lucia</option>
<option>Saint Pierre and Miquelon</option>
<option>Saint Vincent and the Grenadines</option>
<option>Samoa</option>
<option>San Marino</option>
<option>Sao Tome and Principe</option>
<option>Saudi Arabia</option>
<option>Senegal</option>
<option>Serbia and Montenegro</option>
<option>Seychelles</option>
<option>Sierra Leone</option>
<option>Singapore</option>
<option>Slovakia</option>
<option>Slovenia</option>
<option>Solomon Islands</option>
<option>Somalia</option>
<option>South Africa</option>
<option>South Georgia and the South Sandwich Islands</option>
<option>Spain</option>
<option>Spratly Islands</option>
<option>Sri Lanka</option>
<option>Sudan</option>
<option>Suriname</option>
<option>Svalbard</option>
<option>Swaziland</option>
<option>Sweden</option>
<option>Switzerland</option>
<option>Syria</option>
<option>Taiwan</option>
<option>Tajikistan</option>
<option>Tanzania</option>
<option>Thailand</option>
<option>Timor-Leste</option>
<option>Togo</option>
<option>Tokelau</option>
<option>Tonga</option>
<option>Trinidad and Tobago</option>
<option>Tromelin Island</option>
<option>Tunisia</option>
<option>Turkey</option>
<option>Turkmenistan</option>
<option>Turks and Caicos Islands</option>
<option>Tuvalu</option>
<option>Uganda</option>
<option>Ukraine</option>
<option>United Arab Emirates</option>
<option>United Kingdom</option>
<option>United States</option>
<option>Uruguay</option>
<option>Uzbekistan</option>
<option>Vanuatu</option>
<option>Venezuela</option>
<option>Vietnam</option>
<option>Virgin Islands</option>
<option>Wake Island</option>
<option>Wallis and Futuna</option>
<option>West Bank</option>
<option>Western Sahara</option>
<option>Yemen</option>
<option>Zambia</option>
<option>Zimbabwe</option>
</select></td>
</tr>
<tr>
<td>Male / Female:</td>
<td><input name="MaleorFemale" type="radio" id="MaleorFemale" value="M" />
<label for="MaleorFemale">Male<br />
<input type="radio" name="MaleorFemale" id="MaleorFemale2" value="F" />
Female
</label></td>
</tr>
<tr>
<td>Race Group:</td>
<td><input name="RaceGroup" type="radio" id="MaleorFemale3" value="Asian" />
Asian<br />
<input name="RaceGroup" type="radio" id="MaleorFemale4" value="African" />
African<br />
<input name="RaceGroup" type="radio" id="MaleorFemale5" value="Coloured" />
Coloured<br />
<input name="RaceGroup" type="radio" id="MaleorFemale6" value="White" />
White
</td>
</tr>
<tr>
<td>Do you have a disability?</td>
<td><input name="Disability" type="radio" id="MaleorFemale7" value="Y" />
Yes<br />
<input name="Disability" type="radio" id="MaleorFemale8" value="N" />
No
</td>
</tr>
<tr>
<td>If so, indicate the nature:</td>
<td>Nature: <input name="DisabilityNature" type="text" id="DisabilityNature" size="40" value="<?php echo $_REQUEST["DisabilityNature"]; ?>" /></td>
</tr>
<tr>
<td>Related professional council</td>
<td><select name="ProfessionalCouncil" id="ProfessionalCouncil">
<option>None</option>
<option>The South African Council for the Architectural Profession (SACAP)</option>
<option>The South African Council of Planners (SACPLAN)</option>
<option>Engineering Council of South Africa (ECSA)</option>
<option>The South African Council for the Quantity Surveying Profession (SACQSP)</option>
</select></td>
</tr>
<tr>
<td>Belongs to:</td>
<td><input type="radio" name="belongsto" id="belongsto" value="CESA" />
<label for="belongsto">CESA<br />
<input type="radio" name="belongsto" id="belongsto2" value="SABTACO" />
SABTACO<br />
<input type="radio" name="belongsto" id="belongsto3" value="CESA/SABTACO" />
CESA/SABTACO<br />
<!--<input type="radio" name="belongsto" id="belongsto4" value="Neither" />
Neither--> </label></td>
</tr>
<tr>
<td>CESA / SABTACO membership number:</td>
<td><label for="cesamemnum"></label>
<input type="text" name="cesamemnum" id="cesamemnum" /></td>
</tr>
<tr>
<td>Category of registration:</td>
<td><select name="CategoryReg" id="CategoryReg">
<optgroup label="Architects">
<option>Candidate Architect</option>
<option>Candidate Senior Architectural Technologist</option>
<option>Candidate Architectural Technologist</option>
<option>Candidate Architectural Draughtsperson</option>
</optgroup>
<optgroup label="Town Planners">
<option>Professional Planner</option>
<option>Technical Planner</option>
</optgroup>
<optgroup label="Engineers">
<option>Candidate Engineer</option>
<option>Engineer</option>
<option>Engineering Technologist</option>
<option>Engineering Technician</option>
</optgroup>
<optgroup label="Quantity Surveyors">
<option>ND Building</option>
<option>BTech QS</option>
<option>BSc QS</option>
<option>BSc Hon QS</option>
</optgroup>
</select></td>
</tr>
<tr>
<td>Council registration number (if applicable):</td>
<td><input name="CouncilRegNumber" type="text" id="CouncilRegNumber" size="30" value="<?php echo $_REQUEST["CouncilRegNumber"]; ?>" /></td>
</tr>
<tr>
<td>How long have you been registered as a candidate?</td>
<td><input name="LengthCandidateReg" type="text" id="LengthCandidateReg" size="50" value="<?php echo $_REQUEST["LengthCandidateReg"]; ?>" /></td>
</tr>
<tr>
<td>How many years left to professional registration?</td>
<td><input name="YearsToProfReg" type="text" id="YearsToProfReg" size="50" value="<?php echo $_REQUEST["YearsToProfReg"]; ?>" /></td>
</tr>
<tr>
<td>Start date of first job post qualification:</td>
<td><input name="FirstJobStart" type="text" id="FirstJobStart" size="50" value="<?php echo $_REQUEST["FirstJobStart"]; ?>" /></td>
</tr>
<tr>
<td>Voluntary association to which candidate / firm belongs:</td>
<td><select name="VolAssociations" id="VolAssociations">
<optgroup label="Architects">
<option>South African Institute of Architects (SAIA)</option>
<option>South African Insitute of Architectural Technologists (SAIAT)</option>
<option>South African Institute of Interior Design Professions (IID)</option>
<option>South African Institute of Building Designers (SAIBD)</option>
<option>South African Institute of Draughting (SAID)</option>
<option>Border-Kei Institute of Architects (BKIA)</option>
<option>Cape Institute for Architecture (CIfA)</option>
<option>Eastern Cape Institute of Architects (ECIA)</option>
<option>Free State Institute of Architects (FSIA)</option>
<option>Gauteng Institute for Architecture (GIfA)</option>
<option>KwaZulu-Natal Institute for Architecture (KZNIA)</option>
<option>Pretoria Institute of Architects (PIA)</option>
</optgroup>
<optgroup label="Town Planners">
<option>South African Planning institute (SAPI)</option>
<option>South African Association of Consulting Professional Planners - North Region (SAACPP)</option>
<option>South African Association of Consulting Professional Planners - South Region (SAACPP)</option>
</optgroup>
<optgroup label="Engineers">
<option>Aeronautical Society of South Africa (AeSSA) </option>
<option>Association of Mine Managers of South Africa (AMMSA) </option>
<option>Association of Mine Resident Engineers (AMRE) </option>
<option>Association of Municipal Electricity Undertakings (AMEU) </option>
<option>Built Environment Professions Export Council (BEPEC) </option>
<option>Clinical Engineering Association Of South Africa (CEASA) </option>
<option>Concrete Society of Southern Africa (CSSA) </option>
<option>Consulting Engineers South Africa (CESA ) </option>
<option>Illumination Engineering Society of South Africa (IESSA) </option>
<option>Institute of Electrical and Electronic Engineers South African Section (IEEE) </option>
<option>Institute of Professional Engineering Technologists (IPET) </option>
<option>Institute of Quarrying Southern Africa (IQSA) </option>
<option>Institute of Timber Construction (ITC) </option>
<option>Institution of Certificated Mechanical and Electrical Engineering (ICMEESA ) </option>
<option>Institution of Municipal Engineering of Southern Africa (IMESA) </option>
<option>International Council on Systems Engineering (SA Chapter) (INCOSE SA) </option>
<option>Lift Inspectors Association of South Africa (LIASA) </option>
<option>National Society of Black Engineers (NSBE) </option>
<option>Society For Asphalt Technology (SAT) </option>
<option>Society of Telkom Engineers (STE) </option>
<option>South African Colliery Engineers’ Association (SACEA) </option>
<option>South African Colliery Managers Association (SACMA) </option>
<option>South African Federation of Civil Engineering Contractors (SAFCEC) </option>
<option>South African Federation of Hospital Engineers (SAFHE) </option>
<option>South African Flameproof Association (SAFA) </option>
<option>South African Fluid Power Association (SAFPA) </option>
<option>South African Institute of Agricultural Engineers (SAIAE) </option>
<option>South African Institute of Draughting (SAID) </option>
<option>South African Institute of Electrical Engineers (SAIEE) </option>
<option>South African Institute of Marine Engineers and Naval Architects (SAIMENA) </option>
<option>South African Institute of Measurement and Control (SAIMC) </option>
<option>South African Institute of Refrigeration and Air-Conditioning (SAIRAC) </option>
<option>South African Institute of Steel Construction (SAISC) </option>
<option>South African Institute of Welding (SAIW) </option>
<option>South African Institution of Chemical Engineers (SAIChE) </option>
<option>South African Institution of Civil Engineering (SAICE) </option>
<option>South African Road Federation (SARF) </option>
<option>Southern African Asset Management Association (SAAMA) </option>
<option>Southern African Institute for Industrial Engineers (SAIIE) </option>
<option>Southern African Institute of Mining And Metallurgy (SAIMM) </option>
<option>Southern African Society For Trenchless Technology (SASTT) </option>
<option>The Chamber of Engineering Technology (COET) </option>
<option>The South African Institution of Mechanical Engineering (SAIMechE) </option>
<option>Water Institute of Southern Africa (WISA) </option>
</optgroup>
<optgroup label="Quantity Surveyors">
<option>The Association of South African Quantity Surveyors (ASAQS)</option>
<option>South African Property Owners Association (SAPOA)</option>
<option>Chartered Institute of Building (CIOB)</option>
</optgroup>
</select></td>
</tr>
<tr>
<td>Area of Discipline:</td>
<td><!--<select name="AreaDiscipline" id="AreaDiscipline">
<optgroup label="Chemical engineering">
<option>Biomolecular engineering</option>
<option>Materials engineering</option>
<option>Molecular engineering</option>
<option>Process engineering</option>
</optgroup><optgroup label="Civil engineering">
<option>Architectural engineering</option>
<option>Environmental engineering</option>
<option>Geotechnical engineering</option>
<option>Infrastructure</option>
<option>Structural engineering</option>
<option>Transport engineering</option>
</optgroup><optgroup label="Electrical engineering">
<option>Computer engineering</option>
<option>Hardware engineering</option>
<option>Electronic engineering</option>
<option>Telecommunications engineering</option>
<option>Power engineering</option>
</optgroup><optgroup label="Mechanical engineering">
<option>Aerospace Engineering</option>
<option>Acoustical engineering</option>
<option>Manufacturing engineering</option>
<option>Thermal engineering</option>
<option>Vehicle engineering</option>
</optgroup><optgroup label="Interdisciplinary and specialized fields">
<option>Agricultural engineering</option>
<option>Applied engineering </option>
<option>Biological engineering</option>
<option>Building services engineering</option>
<option>Energy engineering</option>
<option>Industrial engineering</option>
<option>Mechatronics</option>
<option>Nano engineering</option>
<option>Nuclear engineering</option>
</optgroup><optgroup label="Architects">
<option>System/Product architect</option>
<option>Domain Architect</option>
<option>Solution Architect</option>
<option>Applied Architect</option>
<option>Enterprise architect</option>
</optgroup><optgroup label="Town Planners">
<option>Transportation Planning </option>
<option>Urban Planning </option>
<option>Rural/ Regional planning </option>
<option>Geographic Information System (GIS)</option>
<option>Development planning</option>
<option>Development economics </option>
</optgroup><optgroup label="Architects">
<option>Rehabilitation </option>
<option>Urban rehabilitation </option>
<option>Project management </option>
</optgroup>
</select>--><input name="AreaDiscipline" type="text" id="AreaDiscipline" size="50" value="<?php echo $_REQUEST["AreaDiscipline"]; ?>" />
</td>
</tr>
<!-- <tr>
<td>Area of Sub-discipline:</td>
<td><input name="AreaSubDiscipline" type="text" id="AreaSubDiscipline" size="50" value="<?php echo $_REQUEST["AreaSubDiscipline"]; ?>" /></td>
</tr> -->
<tr>
<td><p>Telephone No:</p></td>
<td><p>
<input name="Telephone" type="text" id="Telephone" size="30" value="<?php echo $_REQUEST["Telephone"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>Cell No. :</p></td>
<td><p>
<input name="Cellphone" type="text" id="Cellphone" size="30" value="<?php echo $_REQUEST["Cellphone"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>E-mail Address:</p></td>
<td><p>
<input name="EmailAddress" type="text" id="EmailAddress" size="50" value="<?php echo $_REQUEST["EmailAddress"]; ?>" />
</p></td>
</tr>
<tr>
<td valign="top">Work Physical Address:</td>
<td><textarea name="WorkAddress" id="WorkAddress" cols="45" rows="5"><?php echo stripslashes($_REQUEST["WorkAddress"]); ?>
</textarea></td>
</tr>
<tr>
<td valign="top">Province:</td>
<td><select name="Province" id="Province">
<option>Eastern Cape</option>
<option>Free State</option>
<option>Gauteng</option>
<option>KwaZulu-Natal</option>
<option>Limpopo</option>
<option>Mpumalanga</option>
<option>North West</option>
<option>Northern Cape</option>
<option>Western Cape</option>
</select></td>
</tr>
<!-- <tr>
<td valign="top">Postal Address:</td>
<td><textarea name="PostalAddress" id="PostalAddress" cols="45" rows="5"><?php echo stripslashes($_REQUEST["PostalAddress"]); ?>
</textarea></td>
</tr>
<tr>
<td valign="top">VAT No:</td>
<td><input name="VATNo" type="text" id="VATNo" size="30" value="<?php echo $_REQUEST["VATNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Salary (Basic):</td>
<td><input name="Salary" type="text" id="Salary" size="30" value="<?php echo $_REQUEST["Salary"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Bank account details (candidate, not company):</td>
<td align="right">Name: <input name="BankAccountName" type="text" id="BankAccountName" size="40" value="<?php echo $_REQUEST["BankAccountName"]; ?>" /><br />Bank:
<input name="BankAccountBank" type="text" id="BankAccountBank" size="40" value="<?php echo $_REQUEST["BankAccountBank"]; ?>" /><br />
Branch:
<input name="BankAccountBranch" type="text" id="BankAccountBranch" size="40" value="<?php echo $_REQUEST["BankAccountBranch"]; ?>" /><br />
Number:
<input name="BankAccountNo" type="text" id="BankAccountNo" size="40" value="<?php echo $_REQUEST["BankAccountNo"]; ?>" /></td>
</tr>-->
<tr>
<td valign="top">Do you have funding from any other skills development programme/project funded by a public institution? (Describe)</td>
<td><textarea name="Funding" id="Funding" cols="45" rows="2"><?php echo stripslashes($_REQUEST["Funding"]); ?></textarea></td>
</tr>
<!-- <tr>
<td valign="top">Does your company have a structured Candidate Workplace Development/ Training Plan?</td>
<td><input name="CWDTP" type="radio" id="MaleorFemale11" value="Y" />
Yes<br />
<input name="CWDTP" type="radio" id="MaleorFemale12" value="N" />
No </td>
</tr>-->
<tr>
<td valign="top">Mentor Name:</td>
<td><input name="MentorName" type="text" id="MentorName" size="50" value="<?php echo $_REQUEST["MentorName"]; ?>" /></td>
</tr>
<!-- <tr>
<td valign="top">Designation:</td>
<td><input name="MentorDesig" type="text" id="MentorDesig" size="50" value="<?php echo $_REQUEST["MentorDesig"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Professional Registration No:</td>
<td><input name="MentorProfRegNo" type="text" id="MentorProfRegNo" size="50" value="<?php echo $_REQUEST["MentorProfRegNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Mentor's Registration No:</td>
<td><input name="MentorRegNo" type="text" id="MentorRegNo" size="50" value="<?php echo $_REQUEST["MentorRegNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="MentorTel" type="text" id="MentorTel" size="30" value="<?php echo $_REQUEST["MentorTel"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="MentorCell" type="text" id="MentorCell" size="30" value="<?php echo $_REQUEST["MentorCell"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="MentorEmail" type="text" id="MentorEmail" size="50" value="<?php echo $_REQUEST["MentorEmail"]; ?>" /></td>
</tr>
-->
<tr>
<td valign="top">Supervisor Name:</td>
<td><input name="SupervisorName" type="text" id="SupervisorName" size="50" value="<?php echo $_REQUEST["SupervisorName"]; ?>" /></td>
</tr>
<!-- <tr>
<td valign="top">Designation:</td>
<td><input name="SupervisorDesig" type="text" id="SupervisorDesig" size="50" value="<?php echo $_REQUEST["SupervisorDesig"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Professional Registration No: (if applicable)</td>
<td><input name="SupervisorProfRegNo" type="text" id="SupervisorProfRegNo" size="50" value="<?php echo $_REQUEST["SupervisorProfRegNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="SupervisorTelNo" type="text" id="SupervisorTelNo" size="30" value="<?php echo $_REQUEST["SupervisorTelNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="SupervisorCellNo" type="text" id="SupervisorCellNo" size="30" value="<?php echo $_REQUEST["SupervisorCellNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="SupervisorEmail" type="text" id="SupervisorEmail" size="50" value="<?php echo $_REQUEST["SupervisorEmail"]; ?>" /></td>
</tr>
<tr>
<td valign="top"><strong>HR Manager:</strong></td>
<td><input name="HRManagerName" type="text" id="HRManagerName" size="50" value="<?php echo $_REQUEST["HRManagerName"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Designation:</td>
<td><input name="HRManagerDesignation" type="text" id="HRManagerDesignation" size="50" value="<?php echo $_REQUEST["HRManagerDesignation"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="HRManagerTelNo" type="text" id="HRManagerTelNo" size="30" value="<?php echo $_REQUEST["HRManagerTelNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="HRManagerCellNo" type="text" id="HRManagerCellNo" size="30" value="<?php echo $_REQUEST["HRManagerCellNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="HRManagerEmail" type="text" id="HRManagerEmail" size="50" value="<?php echo $_REQUEST["HRManagerEmail"]; ?>" /></td>
</tr>
-->
<tr>
<td valign="top">Application Loaded By:</td>
<td><input name="BookedByName" type="text" id="BookedByName" size="50" value="<?php echo $_REQUEST["BookedByName"]; ?>" /></td>
</tr>
<!-- <tr>
<td valign="top">Designation:</td>
<td><input name="BookedByDesignation" type="text" id="BookedByDesignation" size="50" value="<?php echo $_REQUEST["BookedByDesignation"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="BookedByTelNo" type="text" id="BookedByTelNo" size="30" value="<?php echo $_REQUEST["BookedByTelNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Fax No:</td>
<td><input name="BookedByFaxNo" type="text" id="BookedByFaxNo" size="30" value="<?php echo $_REQUEST["BookedByFaxNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="BookedByCellNo" type="text" id="BookedByCellNo" size="30" value="<?php echo $_REQUEST["BookedByCellNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="BookedByEmail" type="text" id="BookedByEmail" size="50" value="<?php echo $_REQUEST["BookedByEmail"]; ?>" /></td>
</tr>
<tr>
<td valign="top"><strong>South African - Highest Examinations Passed:</strong></td>
<td> </td>
</tr>
<tr>
<td valign="top">Educational Institution:</td>
<td><select name="EducationalInst" id="EducationalInst">
<optgroup label="University">
<option>University of Johannesburg</option>
<option>University of Cape Town</option>
<option>Rhodes University</option>
<option>University of KwaZulu Natal</option>
<option>University of Pretoria</option>
<option>Stellenbosch University</option>
<option>University of the Witwatersrand</option>
<option>North West University </option>
<option>University of the Free State</option>
<option>University of Venda</option>
<option>University of the Western Cape</option>
<option>University of Limpopo</option>
<option>University of Fort Hare</option>
<option>University of South Africa</option>
<option>Walter Sisulu University</option>
<option>Nelson Mandela Metropolitan University</option>
</optgroup>
<optgroup label="University of Technikons">
<option>Cape Peninsula University of Technology</option>
<option>Durban University of Technology </option>
<option>Central University of Technology </option>
<option>Mangosutho University of Technology </option>
<option>Tshwane University of Technology </option>
<option>Vaal University of Technology</option>
</optgroup>
<optgroup label="Technikons">
<option>Border Technikon</option>
<option>Cape Technikon</option>
<option>Natal Technikon</option>
<option>ML Sultan Technikon</option>
<option>Eastern Cape Technikon</option>
<option>Free State Technikon</option>
<option>Mangosutho Technikon</option>
<option>Northern Technikon</option>
<option>Peninsula Technikon</option>
<option>Port Elizabeth Technikon</option>
<option>Pretoria Technikon</option>
<option>Technikon SA</option>
<option>Vaal Technikon</option>
<option>Technikon Witwatersrand</option>
</optgroup>
<option>Other</option>
</select><br/>
<input type="text" name="EducationInstOther" id="EducationInstOther" value="<?php echo $_REQUEST["EducationInstOther"]; ?>" />
</td>
</tr>-->
<tr>
<td valign="top">Qualifications Attained:</td>
<td><label for="Qualifications"></label>
<textarea name="Qualifications" id="Qualifications" cols="45" rows="2"><?php echo $_REQUEST["Qualifications"]; ?></textarea></td>
</tr>
<tr>
<td valign="top">Date of Final Examination:</td>
<td><input name="DateFinalExam" type="text" id="DateFinalExam" size="10" value="<?php echo $_REQUEST["DateFinalExam"]; ?>" /></td>
</tr>
<!-- <tr>
<td valign="top"><strong>Documents:</strong></td>
<td> </td>
</tr>
<tr>
<td valign="top">Certified copy of ID or passport:</td>
<td><input type="file" name="IDFile" id="IDFile" /></td>
</tr>
<tr>
<td valign="top">Curriculum Vitae (CV):</td>
<td><label>
<input type="file" name="CVFile" id="CVFile" />
</label></td>
</tr>
<tr>
<td valign="top">Certified copies of qualification/s:</td>
<td><input type="file" name="QualCertificate1" id="QualCertificate1" />
<br />
<input type="file" name="QualCertificate2" id="QualCertificate2" />
<br />
<input type="file" name="QualCertificate3" id="QualCertificate3" /></td>
</tr>
<tr>
<td valign="top">Undertaking from Mentor (if applicable):</td>
<td><input type="file" name="MentorUndertaking" id="MentorUndertaking" /></td>
</tr>
<tr>
<td valign="top">Undertaking of C&U (ECSA):</td>
<td><input type="file" name="CandUUndertaking" id="CandUUndertaking" /></td>
</tr>
<tr>
<td valign="top">Company Candidate Policy:</td>
<td><input type="file" name="CompanyCandidatePolicy" id="CompanyCandidatePolicy" /></td>
</tr>
<tr>
<td valign="top">Cerificate of disability (if applicable):</td>
<td><input type="file" name="DisabilityCertificate" id="DisabilityCertificate" /></td>
</tr>
<tr>
<td valign="top">Payslip:</td>
<td><input type="file" name="Payslip" id="Payslip" /></td>
</tr>
<tr>
<td valign="top">Proof of bank account:</td>
<td><input type="file" name="BankAccountProof" id="BankAccountProof" /></td>
</tr>
<tr>
<td valign="top">Photograph of candidate:</td>
<td><input type="file" name="Photograph" id="Photograph" /></td>
</tr>-->
</tbody>
</table>
<br />
<p><strong>Terms and Conditions:</strong></p>
<ul>
<li>The Candidate must be a full time staff member of a CESA and/or SABTACO member firm.</li>
<li>The Candidate, Mentor, supervisor and organisation will be required to enter into a Candidacy Agreement.</li>
<li>The annual membership subscriptions to CESA and/or SABTACO must be up to date and the firm must be in good standing.</li>
<li>The organisation must ensure the following:
<ul><li>The Candidate has a Mentor to oversee the implementation and completion of the programme. A registered Mentor will only be required if it is a requirement of the relevant Council.</li>
<li>Be able to provide a project/s and a technical supervisor/s oversight or agree for the Candidate to be rotated or transferred to other departments to able to provide the required project experience and supervision.</li>
<li>Ensure that the candidate submits all reports and documents on time, which are comprehensible and of a high standard, as required by CESA/SABTACO and the relevant professional Council for registration.</li>
<li>A minimum of 50 hours mentoring per annum per candidate, depending on locality, must be provided to the candidate.</li>
<li>Provide the graduate with an e-mail address and access to the internet for purposes of research, assignments and monthly reporting.</li>
<li>If not already done so, support the candidate to register as a candidate with their relevant professional Council</li>
<li>Allow the Candidate to attend any supplementary technical or soft skills courses considered necessary - these would normally not exceed 6 days of training per annum.</li>
<li>Allow the Mentor and one Supervisor to attend a Road to Registration for Mentor and Supervisors Courses. This course is subsidised by the funding grant.</li>
</ul></li>
<li>If your organisation does not have a training plan, it will be your responsibility to use a portion of its funding to appoint an outside service provider to assist with this process. A list of approved service providers can be requested from the CESA/SCE website (www.cesa.co.za/mentanet).</li>
<li>All candidates selected for support should be South African citizens and must have a South African degree or diploma from a University, University of Technology or former Technikon.</li>
<li>It is a requirement of the CETA that we check that all candidates are earning more than R2 500.00 per month and have a bank account into which their salaries are being paid, and that the correct statutory deductions are being made. We would therefore also ask for payslips to be submitted.</li>
</ul>
<p>
<input type="checkbox" name="Accept_Policy" id="Accept_Policy" value="yes" />
I have read and accept the terms and conditions</p>
<p><?php include "../php/inc_captcha.php"; ?>
<img src="/php/CaptchaSecurityImages.php?security_code=<?php echo $_SESSION['security_code']; ?>" /><br />
<br />
Please type the verification code, exactly as you see it above, into the box below.<br />
<br />
<input id="security_code" name="security_code" type="text" />
<input type="hidden" name="ti" value="<?php echo md5($_SESSION['security_code']); ?>" />
</p>
<p>
<input type="submit" name="Submit" id="Submit" value="Submit" style="background-color:red;color:white;font-style:bold;width:150px;height:50px" /> <!--<b>Please be patient, submission can take time if the documents to upload are large.</b>-->
</p>
</form>
<?php
}
?>
<br />
<p> </p>
<?php
}
?>
</div>
<?php include("inc_footer.php"); ?>
<!-- end #container --></div>
</body>
</html>