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: