LCL Form Rs 002 Application Form 2018

Life Healthcare Group (Pty) Ltd is registered as a Private Higher Education College with the DHET.
Registration Number 2008/HE07/00
Application Form – 2018
College Vision
To create a skilled workforce for Life Healthcare and the healthcare
industry in order to provide cost effective, quality and competent patient
care.
College Mission
 To retain and develop staff for Life Healthcare
 To ensure staff have career development opportunities
 To develop a competent workforce
 To work according to necessary legislation governing education,
training and development in the healthcare industry.
Company values
 Passions for people
 Quality
 Performance pride
 Personal care
 Lifetime partnerships
Information
LCL-Form-RS-002 Revision 10 – June 2017 Page 1 of 6
1. All candidates must complete all applicable sections on the application form
2. Only successful applicants will receive a confirmation letter.
3. The Nursing Manager of an internal student will be informed if this candidate is

successful.
4. Students enrolled on the programme must have a personal computer with

internet access and be computer literate.
5. Additional Documentation
The following additional documentation must be submitted with this

application. Applications with missing documentation will not be reviewed.
 Certified copies of:

o Identity document
o Marriage certificate (if applicable)
o Matric (Grade 12/Standard 10) Certificate
o Other certificates/diplomas and examination results as applicable
o Curriculum vitae (CV)
 Current SANC receipt, if applicable
6. Application Fee
The application fee for any programme offered at the College is R400.00 and must
be paid prior to submitting the application form and a deposit slip or proof of
electronic payment must be submitted with this application form. The application fee
is non-refundable. The bank account details are as follows:
Administration and Tuition Fee:

Life Healthcare Group (Pty) Ltd – Nursing College
First National Bank
Branch: Corporate Account Services, Johannesburg
Account Number: 62092216201
Branch Number: 255-655
Please use abbreviation of the learning centre, your ID number and the words
‘Admin fee’ as reference e.g. PE ID Number Admin Fee

7. Recognition of Prior Learning
Credit and requests for exemption must be completed at the time of application
for admission and are subject to approval of the recognition of prior learning
committee.
8. Declaration
I, the undersigned applicant, do hereby:
a) Acknowledge that I understand the provisions of the declarations herein and am bound by the
provisions of this registration, and the rules and procedures of Life Healthcare (PTY) Ltd (LHC)
currently in force and/or which may be amended at a later date.
b) Acknowledge that I have familiarised myself with the prospectus of the relevant programme for
which I have applied to register and certify that the information provided in this form is accurate and
complete.
c) Confirm that I have to satisfy the requirements of due performance as laid down by LHC.
d) Hold myself responsible for the payment of full tuition fees relating thereto, notwithstanding the fact
that my employer/sponsor has undertaken to pay the full tuition fees relating thereto.
e) Agree that where tuition fees are payable to LHC in instalments, failure to pay any single instalment
timeously will result in the full amount owing becoming due and payable immediately.
f) Agree that LHC shall be entitled to recover from me all legal costs incurred in order to enforce its
rights under this contract, including, but not by way of limitation, attorneys and own client fees and
collection charges and all tracing charges.
g) Agree that LHC reserves the right to withhold programme/module results should there be any
default in payments according to this signed Enrolment Contract.
h) Accept that if I choose a payment plan, I am in a position to fulfil my financial obligations to LHC
i) Accept that I may cancel my registration for the current year of study as a whole and shall be
exonerated from the liability for the full fee (excluding the application fee) provided that LHC is
informed in writing within 14 days of registration.
j) Agree that LHC may approach credit agencies with a view of ascertaining my credit record and that
in the event of me being in arrears with this account or failing to pay it, then LHC shall have an
irrevocable right to inform credit agencies thereof.
k) Agree that should my account not be settled within the stipulated date, non-settlement will attract a
penalty.
l) Acknowledge that an invoice issued by LHC, shall be proof of the full amount owing by the student
for the purpose of all legal proceedings.
m) Acknowledge that, notwithstanding the existence of appeal processes, the academic judgement of
LHC will be regarded as final.
n) Accept and agree to adhere by the rules, policies and procedures as set out by LHC.
o) Agree to pay the non-refundable application fee.
p) All learning materials and resources are to be used by the registered student only and cannot be
shared or replicated under any circumstances, in part or full at any time. LHC has a vested right to all
learning material, resources and related intellectual property. Confidentiality constitutes a serious
aspect of the relationship between the student and LHC.
Student signature : Date:

Guardian signature: Date
(if student is under 18 years old)
Note: THE COLLEGE RESERVES THE RIGHT TO VERIFY ANY INFORMATION

SUBMITTED

Section A
Line Manager Details
(Compulsory for candidates who are employed with LHC)
1 Name
2 Surname
3 Business Unit
4 Job Title
5 Contact Number
SECTION B
Photo of
Applicant: Personal and Company Details
student
(To be completed by the candidate)
1 Name and Surname
2 Race  African
 White
 Coloured
 Indian
3 Gender  Male
 Female
4 Internal Candidates Hospital Unit:
Current Position:
LHC Employee Number:
Email address:
5 Identity Number
6 Telephone Number
7 Mobile Number
8 Physical Address
9 Highest Qualifications (add Qualifications:
all qualifications and Year Qualified:
submit copy of certificate
More Qualifications
Qualifications: Qualifications: Qualifications: Qualifications:
Year Qualified: Year Qualified: Year Qualified: Year Qualified:
10 Next of Kin Name:

Contact Number:
11 Current Employer
12 Business Telephone
Number
13 Work Address
14 SANC reference number
15 Work experience related to Position:
the programme applied for Start Date:

End Date:
More work Experience
Position: Position: Position:
Start Date: Start Date: Start Date:
End Date: End Date: End Date:
16 Signature of Applicant
17 Signature of Nursing
Manager
18 Admin fee deposit
reference number (as
entered on bank deposit
slip)
19 Where did you hear about  Newspaper advert
Life College of Learning :  Employer
 Own initiative
 Students
 Web
 Mail / Brochure
 Colleagues
 Other
20 The submission of the  Yes

details on the application  No
form infers consent to
personal information being
shared amongst the
recruitment and selection
team and the learning
centre for the purpose of
recruitment and selection
21 Please select which  Cape Town
learning centre you would  Kwa Zulu-Natal
like to attend, please refer  East London
to the website for the  East Rand
learning centre address  Port Elizabeth
 Pretoria
 West Rand
 Bay view
SECTION C
Available Programmes / Courses – Nursing Education
(To be completed by the candidate)
Indicate the programme you are  Diploma in General Nursing - First
applying for by selecting from Year
the drop down  Diploma in Operating Department
Assistance - First Year (ODA)

 Diploma in Medical and Surgical
Nursing: Critical Care
Nursing: Operating Theatre Nursing
Nursing: Emergency Nursing
Nursing: Occupational Health Nursing
 Diploma in Midwifery
 Certificate in Infection Control
Nursing
 Short Learning Programmes: Mental
Health Nursing
 Short Learning Programmes: High
Care Nursing
 Short Learning Programmes:
Operating Theatre
 Short Learning Programmes:
Neonatal ICU

LCL Form Rs 002 Application Form 2018

Uploaded by

Copyright:

Available Formats

LCL Form Rs 002 Application Form 2018

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

LCL Form Rs 002 Application Form 2018

Uploaded by

Copyright:

Available Formats

Life Healthcare Group (Pty) Ltd is registered as a Private Higher Education College with the DHET.

Registration Number 2008/HE07/00

Application Form – 2018

2. Only successful applicants will receive a confirmation letter.

3. The Nursing Manager of an internal student will be informed if this candidate is

4. Students enrolled on the programme must have a personal computer with

The following additional documentation must be submitted with this

 Certified copies of:

 Current SANC receipt, if applicable

Administration and Tuition Fee:

LCL-Form-RS-002 Revision 10 – June 2017 Page 2 of 6

Student signature : Date:

Note: THE COLLEGE RESERVES THE RIGHT TO VERIFY ANY INFORMATION

LCL-Form-RS-002 Revision 10 – June 2017 Page 3 of 6

Year Qualified: Year Qualified: Year Qualified: Year Qualified:

10 Next of Kin Name:

LCL-Form-RS-002 Revision 10 – June 2017 Page 4 of 6

20 The submission of the  Yes

LCL-Form-RS-002 Revision 10 – June 2017 Page 5 of 6

LCL-Form-RS-002 Revision 10 – June 2017 Page 6 of 6

You might also like