ILM Registration

    Candidate Name:
    Application Date:
    Candidate email address:
    Candidate mobile contact:
    Candidate Address and P.O. Box No.:
    Candidate Home contact:
    Candidate Date of Birth:
    Gender:
    Are you Employed:
    Place of Employment:
    Employer's Address:
    Employer's Name:
    Employer Contact Number:
    Current Position/Status:
    Number of Years of Experience in current position:
    Supervisor's Name:
    Supervisor's Position:
    Supervisor's email address:
    Supervisor's Contact Number:
    Is your supervisor aware that you are seeking training?:
    Curriculum Vitae' Submitted [giving details of job function]:
    Tick the qualification you would like to pursue: ILM Level 2 Qualification-Leadership and team Skills (Award of Certificate)ILM 3 Qualification-Leadership and Management Diploma
    State in 25 words or less what you expect to gain from this course of studies:
    Please Place one Photo Here:

    FOR OFFICIAL USE ONLY

    Pre-screening and assessment with Learner completed?:
    Date Completed:
    Assessor/Tutor Comments:
    Candidate's Signature:
    Date:
    Assessor Signature:
    Date:
    Centre Coordinator's Signature:
    Date: