Short Course Two: Professional Borehole Drilling Supervision
APPLICATION FORM
SHORT COURSE TWO: PROFESSIONAL BOREHOLE DRILLING SUPERVISION
Please answer each question clearly and completely (print or type), read carefully and follow the instructions. Read Instructions on page 5 on sending the form.
PERSONAL INFORMATION
______
Last Name (Family Name)
First Name(s) (Given Names)
Gender
Date of Birth
Town of Birth
Country of Birth
Country of Citizenship
Passport Number
CORRESPONDENCE ADDRESS
______
Address
City
ZIP Code/ Postal Code
Country
Telephone
HIGHEST LEVEL OF EDUCATION
Highest Level of Education
Field of Study (Major)
BACKGROUND
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How many years of experience do you have in supervision of borehole drilling?
What has been your role in supervision of borehole drilling?
MOTIVATION
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Briefly describe your motivation in enrolling in the course. (Max 300 words)
EMPLOYMENT STATUS
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Organisation, name
Dept./Division/ Office
Job Title
Started in year
Address
City
ZIP/Postal Code
Telephone
Type of Organisation
Describe your work, indicating your personal responsibilities (max 300 words)
FUNDING
______
Who will fund for your participation?
Will you require partial funding from the consortium of organisers? State the nature of funding required
EMPLOYER CONFIRMATION
______
We are in a position to release Mr/Ms/Miss/Dr/Prof
to attend the short Course “Professional Drilling Supervision” to be held at the IGS in Bloemfontein in South Africa from the 23rd to the 27th of April 2018
We will/will not be able to fund for the costs of attending the training
We will require partial funding in the form of from the consortium of organisers for the following;
Signed
Position
Date
DECLARATION
______
The undersigned certifies that his/her statements made in answer to the foregoing questions are true, complete and correct. The undersigned applies for short course admission by returning this form with the attached CV.
Date Place
Signature
MISCELLANEOUS
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How did you hear about the course?
Applications
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Applicants should send their curriculum vitae along with a completed application form to the organisers. Applications should be sent to . The subject line of the email should be “Professional Borehole Drilling Supervision”
The deadline for receiving of applications is the 30th March l 2018. Accepted applicants will be informed by the 6th of April 2018