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
$bCourseFull = false;
if (isset($_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) {
global $row;
for ($a=0; $a<count($arr); $a++) {
$sel="";
if (($row[$sSelName]==$arr[$a]) || $_REQUEST[$sSelName]==$arr[$a]) $sel=" selected";
echo "<option value='".addslashes($arr[$a])."'".$sel.">".$arr[$a]."</option>";
}
}
if (isset($_POST["go"]) && ($_POST["go"]==1)) {
$bShowForm = true;
$bWrongID=false;
$sql = "SELECT * FROM CCMStudents WHERE IDNumber='".$_REQUEST["IDNumber"]."'";
$recCheck = mysql_query($sql);
if (mysql_num_rows($recCheck)==0) {
$sMsg .= "<li>The ID number you provided does not exist.</li>";
$bShowForm=true;
$bWrongID=true;
}
mysql_free_result($recCheck);
} elseif (isset($_POST["go"]) && ($_POST["go"]==2)) {
// $bCourseFull = true;
if ($bCourseFull) {
echo "<p style='color:red'><b>Sorry, no more registrations can be accepted.</b></p>";
} else {
if (empty($sMsg)) {
$bShowForm = false;
$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);
}
$sql = "REPLACE INTO `CCMStudents` (CCMStudentID, `Organisation`, `Title`, `FirstName`, `Surname`, `KnownAs`, `JobTitle`, `Department`,
`IDNumber`, `DateofBirth`, `PlaceofBirth`, `CountryofBirth`, `MaleorFemale`, `RaceGroup`, `Disability`, `DisabilityNature`,
`ProfessionalCouncil`, `CategoryReg`, `CouncilRegNumber`, `LengthCandidateReg`, `YearsToProfReg`,
`FirstJobStart`, `VolAssociations`, `AreaDiscipline`, `AreaSubDiscipline`, `Telephone`, `Cellphone`, `EmailAddress`,
`WorkAddress`, `PostalAddress`, `VATNo`, `Salary`, `BankAccountName`, `BankAccountBank`, `BankAccountBranch`,
`BankAccountNo`, `Funding`, `CWDTP`, `MentorName`, `MentorDesig`, `MentorProfRegNo`, `MentorRegNo`,
`MentorTel`, `MentorCell`, `MentorEmail`, `SupervisorName`, `SupervisorDesig`, `SupervisorProfRegNo`, `SupervisorTelNo`,
`SupervisorCellNo`, `SupervisorEmail`, `HRManagerName`, `HRManagerDesignation`, `HRManagerTelNo`, `HRManagerCellNo`,
`HRManagerEmail`, `BookedByName`, `BookedByDesignation`, `BookedByTelNo`, `BookedByFaxNo`, `BookedByCellNo`, `BookedByEmail`,
`EducationalInst`, `Qualifications`, `DateFinalExam`, `BelongsTo`, `CESA_SABTACO_MemNum`,
WebUsername, WebPassword, MentorID, EmployerID,
`IDFile`, `CVFile`, `QualCertificate1`, `QualCertificate2`, `QualCertificate3`,
`MentorUndertaking`, `CandUUndertaking`, `CompanyCandidatePolicy`, `DisabilityCertificate`, `Payslip`, `BankAccountProof`, `Photograph`)
VALUES (".$_POST['CCMStudentID'].", '".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"]))."',
'".addslashes(stripslashes($_POST["WebUsername"]))."', '".addslashes(stripslashes($_POST["WebPassword"]))."',
'".addslashes(stripslashes($_POST["MentorID"]))."', '".addslashes(stripslashes($_POST["EmployerID"]))."',
'".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);
$sForm = '
<table width="643" border="1" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td valign="top">Organisation:</td>
<td>'.$_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, "UPDATE OF INFORMATION FOR SABTACO/CESA Candidacy Programme", $sForm, $headers);
?>
<p><strong>Thank you for updating the information for the SABTACO/CESA Candidacy Programme.</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_step2.php">Click here to update another candidate</a></strong></p>
<hr />
<?php echo $sForm; ?>
<?php
}
}
}
if ($bShowForm) {
?>
<form action="/mentanet/register_step2.php" method="post" enctype="multipart/form-data" name="form1" id="form1">
<h3>INFORMATION UPLOAD FORM: CETA Candidacy Programmes to Culminate in the Registration of Candidates in Designated Professions</h3>
<?php
if (!empty($sMsg)) echo "<p style='color:red'><b>Error:<br /><ul style='color:red'>".$sMsg."</ul></b></p>";
?>
<?php
if (!isset($_REQUEST["IDNumber"]) || $bWrongID) {
?>
<input type="hidden" name="go" value="1" />
<p><strong>Please enter the registered candidate's ID number to continue:</strong></p>
<table width="643" border="1" cellpadding="5" cellspacing="0">
<tr>
<td>South African ID Number:</td>
<td><input name="IDNumber" type="text" id="IDNumber" size="30" value="" /></td>
</tr>
</table>
<?php
} else {
$sql="SELECT * FROM CCMStudents WHERE IDNumber='".$_REQUEST["IDNumber"]."' ORDER BY CCMStudentID DESC";
$rec=mysql_query($sql);
if ($row=mysql_fetch_assoc($rec)) {
?>
<input type="hidden" name="go" value="2" />
<input type="hidden" name="IDNumber" value="<?php echo $row["IDNumber"]; ?>" />
<input type="hidden" name="CCMStudentID" value="<?php echo $row["CCMStudentID"]; ?>" />
<input type="hidden" name="WebUsername" value="<?php echo $row["WebUsername"]; ?>" />
<input type="hidden" name="WebPassword" value="<?php echo $row["WebPassword"]; ?>" />
<input type="hidden" name="MentorID" value="<?php echo $row["MentorID"]; ?>" />
<input type="hidden" name="EmployerID" value="<?php echo $row["EmployerID"]; ?>" />
<p><strong>Please complete the information below.</strong></p>
<table width="643" border="1" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td valign="top">Organisation:</td>
<td><?php echo $row["Organisation"]; ?><input type="hidden" name="Organisation" value="<?php echo addslashes($row["Organisation"]); ?>"></td>
</tr>
<tr>
<td>Title:</td>
<td>
<?php echo $row["Title"]; ?>
<input type="hidden" name="Title" value="<?php echo addslashes($row["Title"]); ?>">
</td>
</tr>
<tr>
<td width="298"><p>First Name:</p></td>
<td width="319"><p>
<?php echo $row["FirstName"]; ?>
<input type="hidden" name="FirstName" value="<?php echo addslashes($row["FirstName"]); ?>">
</p></td>
</tr>
<tr>
<td><p>Surname:</p></td>
<td><?php echo $row["Surname"]; ?><input type="hidden" name="Surname" value="<?php echo addslashes($row["Surname"]); ?>"></td>
</tr>
<tr>
<td><p>Preferred Name (Known As):</p></td>
<td><p>
<?php echo $row["KnownAs"]; ?>
<input type="hidden" name="KnownAs" value="<?php echo addslashes($row["KnownAs"]); ?>">
</p></td>
</tr>
<tr>
<td>Job Title:</td>
<td><?php echo $row["JobTitle"]; ?><input type="hidden" name="JobTitle" value="<?php echo addslashes($row["JobTitle"]); ?>"></td>
</tr>
<tr>
<td>Department:</td>
<td><?php echo $row["Department"]; ?><input type="hidden" name="Department" value="<?php echo addslashes($row["Department"]); ?>"></td>
</tr>
<tr>
<td>South African ID Number (Only):</td>
<td><?php echo $row["IDNumber"]; ?></td>
</tr>
<tr>
<td>Date of Birth:</td>
<td><?php echo $row["DateofBirth"]; ?><input type="hidden" name="DateofBirth" value="<?php echo addslashes($row["DateofBirth"]); ?>"></td>
</tr>
<tr>
<td>Place of Birth:</td>
<td><?php echo $row["PlaceofBirth"]; ?><input type="hidden" name="PlaceofBirth" value="<?php echo addslashes($row["PlaceofBirth"]); ?>"></td>
</tr>
<tr>
<td>Country of Birth:</td>
<td><?php echo $row["CountryofBirth"]; ?><input type="hidden" name="CountryofBirth" value="<?php echo addslashes($row["CountryofBirth"]); ?>"></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 $row["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 $row["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 $row["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 $row["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 $row["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 $row["AreaDiscipline"]; ?>" />
</td>
</tr>
<tr>
<td>Area of Sub-discipline:</td>
<td><input name="AreaSubDiscipline" type="text" id="AreaSubDiscipline" size="50" value="<?php echo $row["AreaSubDiscipline"]; ?>" /></td>
</tr>
<tr>
<td><p>Telephone No:</p></td>
<td><p>
<input name="Telephone" type="text" id="Telephone" size="30" value="<?php echo $row["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 $row["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 $row["EmailAddress"]; ?>" />
</p></td>
</tr>
<tr>
<td valign="top">Work Physical Address:</td>
<td><textarea name="WorkAddress" id="WorkAddress" cols="45" rows="5"><?php echo stripslashes($row["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($row["PostalAddress"]); ?>
</textarea></td>
</tr>
<tr>
<td valign="top">VAT No:</td>
<td><input name="VATNo" type="text" id="VATNo" size="30" value="<?php echo $row["VATNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Salary (Basic):</td>
<td><input name="Salary" type="text" id="Salary" size="30" value="<?php echo $row["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 $row["BankAccountName"]; ?>" /><br />Bank:
<input name="BankAccountBank" type="text" id="BankAccountBank" size="40" value="<?php echo $row["BankAccountBank"]; ?>" /><br />
Branch:
<input name="BankAccountBranch" type="text" id="BankAccountBranch" size="40" value="<?php echo $row["BankAccountBranch"]; ?>" /><br />
Number:
<input name="BankAccountNo" type="text" id="BankAccountNo" size="40" value="<?php echo $row["BankAccountNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Do you have funding from any other skills development programme/project funded by a public institution? (Describe)</td>
<td><textarea name="Funding" id="Funding" cols="45" rows="2"><?php echo stripslashes($row["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 $row["MentorName"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Designation:</td>
<td><input name="MentorDesig" type="text" id="MentorDesig" size="50" value="<?php echo $row["MentorDesig"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Professional Registration No:</td>
<td><input name="MentorProfRegNo" type="text" id="MentorProfRegNo" size="50" value="<?php echo $row["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 $row["MentorRegNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="MentorTel" type="text" id="MentorTel" size="30" value="<?php echo $row["MentorTel"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="MentorCell" type="text" id="MentorCell" size="30" value="<?php echo $row["MentorCell"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="MentorEmail" type="text" id="MentorEmail" size="50" value="<?php echo $row["MentorEmail"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Supervisor Name:</td>
<td><input name="SupervisorName" type="text" id="SupervisorName" size="50" value="<?php echo $row["SupervisorName"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Designation:</td>
<td><input name="SupervisorDesig" type="text" id="SupervisorDesig" size="50" value="<?php echo $row["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 $row["SupervisorProfRegNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="SupervisorTelNo" type="text" id="SupervisorTelNo" size="30" value="<?php echo $row["SupervisorTelNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="SupervisorCellNo" type="text" id="SupervisorCellNo" size="30" value="<?php echo $row["SupervisorCellNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="SupervisorEmail" type="text" id="SupervisorEmail" size="50" value="<?php echo $row["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 $row["HRManagerName"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Designation:</td>
<td><input name="HRManagerDesignation" type="text" id="HRManagerDesignation" size="50" value="<?php echo $row["HRManagerDesignation"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="HRManagerTelNo" type="text" id="HRManagerTelNo" size="30" value="<?php echo $row["HRManagerTelNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="HRManagerCellNo" type="text" id="HRManagerCellNo" size="30" value="<?php echo $row["HRManagerCellNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="HRManagerEmail" type="text" id="HRManagerEmail" size="50" value="<?php echo $row["HRManagerEmail"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Application Loaded By:</td>
<td><input name="BookedByName" type="text" id="BookedByName" size="50" value="<?php echo $row["BookedByName"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Designation:</td>
<td><input name="BookedByDesignation" type="text" id="BookedByDesignation" size="50" value="<?php echo $row["BookedByDesignation"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Tel No:</td>
<td><input name="BookedByTelNo" type="text" id="BookedByTelNo" size="30" value="<?php echo $row["BookedByTelNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Fax No:</td>
<td><input name="BookedByFaxNo" type="text" id="BookedByFaxNo" size="30" value="<?php echo $row["BookedByFaxNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Cell No:</td>
<td><input name="BookedByCellNo" type="text" id="BookedByCellNo" size="30" value="<?php echo $row["BookedByCellNo"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Email Address:</td>
<td><input name="BookedByEmail" type="text" id="BookedByEmail" size="50" value="<?php echo $row["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 $row["EducationInst"]; ?>" />
</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 $row["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 $row["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 />
<b>Please be patient, submission can take time if the documents to upload are large!</b>
<?php
}
}
?>
<p>
<input type="submit" name="Submit" id="Submit" value="Submit" style="background-color:red;color:white;font-style:bold;width:150px;height:50px" />
</p>
</form>
<?php
}
?>
<br />
<p> </p>
<?php
}
?>
</div>
<?php include("inc_footer.php"); ?>
<!-- end #container --></div>
</body>
</html>