Fundamentals & Specialist – Intake Six (August 2023 to February 2024) Section One : Personal Information Full Name (As Per NRIC/Passport) Please indicate your full name as per NRIC/Passport. Your name will be used for course-related registration, certification and all correspondences. Gender FemaleMale Date of Birth Race ---ChineseIndianMalayOthers Nationality ---SingaporeanSingapore PROthers Email Mobile No. Residential Address NRIC No. Upload NRIC (Front & Back) Accepted File Formats: jpeg, pdf Max. File Size: 4 MB/file Front Choose file... Back Choose file... Passport No. Upload PassportAccepted File Formats: jpeg, pdf Max. File Size: 4 MB/file Choose file... Type of Disability Mild Intellectual DisabilityOthersNot Applicable Proof of Disability Accepted File Formats: jpeg, pdf Max. File Size: 4 MB Choose file...Please scan and upload proof of disability (e.g. disability card, doctor's memo). Workplace Literacy and Numeracy (WPLN) Scores Reading ---NA12345678 Listening ---NA12345678 Speaking ---NA12345678 Writing ---NA12345678 Numeracy ---NA12345678 WPLN CertificateAccepted File Formats: jpeg, pdf Max. File Size: 4 MB Choose file... Other Relevant CertificatesAccepted File Formats: jpeg, pdf Max. File Size: 4 MB Choose file... Note: An email regarding payment details of the course fees will be sent to you after the confirmation of your place in the course. Section Two: Declaration I acknowledge and agree that Presbyterian Community Services may collect, use and disclose to any third party any and all particulars relating to my personal information for the purposes of: providing early childhood & care related training and associated services, billing and account management (including debt collection or recovery), conducting surveys or obtaining feedback, informing me of services and offers by Presbyterian Community Services, its related entities and business affiliates (unless I duly inform you otherwise), and complying with all applicable laws and regulations, and business requirements. YesNo I further acknowledge and agree that Presbyterian Community Services may collect, use and disclose my personal information to SG Enable for sharing with relevant government ministries, agencies or other parties for the administration of the funding programme. YesNo Declaration of Medical History Do you have any medical history? Mental Illness YesNo Epilepsy YesNo Tuberculosis YesNo Hepatitis B Carrier YesNo HIV/AIDS YesNo Others YesNo If you have answered “Yes” for any of the above, please state if you are currently on medication, or seeking treatment for your condition/s. Declaration of Employment/Others Please indicate your employment status. I am currently unemployed.I am currently employed on a part time basis. If successfully enrolled for the Course (which I am aware is a full time/full day course) I will resign from my job and commit fully to the Course. Have you been suspended/dismissed/terminated from previous employment before? YesNo Have you had a criminal record or are undergoing probation in Singapore or any other country? YesNo For details of our Privacy Policy, please refer to this page. By submitting this form, this consent shall override my registration with the Singapore Do-Not-Call registry regardless of order of registration.
