National Apprentice and Industrial Training Authority (NAITA)
Sri Lanka Association of Testing Laboratories (SLATL)
“Vidya Mandiraya”, 120/10, Wijerama Mawatha, Colombo 7, Sri Lanka - Tel: 0715364048
NAITA-SLATL COURSE FOR MEDICAL TESTING LABORATORY TECHNICIAN
EDUCATION AND CERTIFICATION
Application Seeking Admission to the Certificate Course for Medical Laboratory Technicians
1. Applicant’s surname (last name) in block capitals Miss/Mrs/Ms/Mr
Other names in block capitals
Name with initials
2. Residential address
Address for correspondence
Permanent address
3. Contact telephone/ mobile number and E-mail address
4. Date of birth and National Identity Card (NID) number*
(attach photocopy of Birth Certificate and photocopy of NID to application)
6. Name and address of the Medical Testing Laboratory in which you are currently employed
7. Date of appointment to the currently employed Medical Testing Laboratory and period of service
8. Name/s and location/s of the Medical Testing Laboratory/Laboratories in which you were
previously employed, chronologically
9. Educational qualifications
9.1. General Certificate of Education (GCE OL)* 9.2. General Certificate of Education (GCE AL)*
(attach photocopies of original / certified GCE OL and GCE AL certificates to application)
GCE OL Subject / Grade / YearGCE AL Subject / Grade / Year
9.3. Further educational / professional qualifications after GCE AL (state below, if any)*
(attach original / certified photocopies of certificate to application)
9.4. Proficiency in English Language (the highest examination passed in English Language)
Declaration by the applicant
I do hereby certify that the information given above by me in filling this application is true and accurate and understand that my application will be rejected and/or studentship will be terminated if decisive information herein is found to be falsified.
Student’s signature Date