Scribd
Upload
89 views6 pages

Application Form Postgraduate Programmes 2025

The document is an application form for postgraduate diploma programmes at Gauteng College of Nursing, detailing required personal information, programme choices, and employment particulars. It includes a checklist of necessary documents to be submitted with the application and emphasizes compliance with the Protection of Personal Information Act. Applicants must ensure all sections are completed and documents attached, as incomplete submissions will be nullified.

Uploaded by

Flora Mogajane
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
89 views6 pages

Application Form Postgraduate Programmes 2025

The document is an application form for postgraduate diploma programmes at Gauteng College of Nursing, detailing required personal information, programme choices, and employment particulars. It includes a checklist of necessary documents to be submitted with the application and emphasizes compliance with the Protection of Personal Information Act. Applicants must ensure all sections are completed and documents attached, as incomplete submissions will be nullified.

Uploaded by

Flora Mogajane
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 6

APPLICATION FORM: POSTGRADUATE DIPLOMA PROGRAMMES R.

635

INSTRUCTIONS: COMPLETE ALL SECTIONS OF THE FORM AND ATTACH THE RELEVANT
DOCUMENTS AS INDICATED BELOW

1. IMPORTANT INFORMATION

All applications at Gauteng College of Nursing (GCON) are processed in accordance with the Protection
of Personal Information (POPI) Act 4 of 2013.

2. PROGRAMMES

Indicate the campus of choice with the number 1 (first choice) and 2 (second choice) where
programmes are offered in more than one campus.

Programme applying for: MARK WITH X


ALC BC GC RMC SGLC

1.1 Child Nursing


1.2 Adult - Critical Care Nursing
1.3 Emergency Nursing
1.4 Mental Health Nursing
1.5 Midwifery
1.6 Nephrology Nursing
1.7 Occupational Health Nursing
1.8 Oncology and Palliative Nursing
1.9 Ophthalmic Nursing
1.10 Orthopaedic Nursing
1.11 Perioperative Nursing
1.12 Primary Care Nursing

CAMPUS OF CHOICE
Abbreviations Full Name
ALC Ann Latsky Campus
BC Bonalesedi Campus
GC Ga-Rankuwa Campus
RMC Rahima Moosa Campus
SGLC SG Lourens Campus

GCON/postgraduate APPLICATION FORM 1


2. PERSONAL INFORMATION

Surname:
First name/s:
Maiden name:
Gender: MARK WITH X
Male Female Other

Date of birth:
Landline number:
Cellular number:
Alternative number:
E-mail address:
MARK WITH X
Are you a South African citizen? Yes No

If No, state your nationality:


Identity number /Passport number
(If applicable)
Country of issue
Study permit Yes No
If “Yes” provide study permit number
Employee number
Professional registration/Practice number
(from country of origin)
South African Nursing Council
registration number
Race (for statistical purposes only):
Do you have any disability? Yes No
If “Yes” please specify

Person responsible for payment of fees


Contact details of person responsible for
payment of fees

Residential address:

Province:

Postal address:

Province: ____________________________

GCON/postgraduate APPLICATION FORM 2


Next of kin
Surname
Name/s
Relationship
Contact number
E-mail address

Information on the status of study leave


Have you been granted study leave?
Yes No

3. EMPLOYMENT PARTICULARS

a. Current employer’s contact details

Current employer
Contact person
Designation

Telephone No.
Fax No.
E-mail address
Postal address

Postal code
Province

GCON/postgraduate APPLICATION FORM 3


b. Work experience in the field applied for

EMPLOYER INSTITUTION POST/RANK DEPARTMENT/ PERIOD


SPECIALTY

c. Employment/Reference information

NB! The following information to be filled in by the employer or representative to indicate his/her
intentions to release the applicant to study.

Candidate`s full names:

Period under your employment:

i. Does the applicant have the experience in area of intended study?


Yes No

ii. If yes, indicate the period:


Years Months

iii. Is the applicant granted permission to study?


Yes No

GCON/postgraduate APPLICATION FORM 4


Motivation for approval of study leave

Name and surname (Employer or Representative):

Designation:

Signature: Date:

Official Stamp from Employer

GCON/postgraduate APPLICATION FORM 5


4. CHECKLIST PRIOR SUBMISSION

No. HAVE YOU ATTACHED THE FOLLOWING? For Applicant For Office Use
(MARK WITH X) Only
YES NO N/A YES NO N/A
5.1 Completed Application Form
5.2 One passport-sized photograph
5.3 Identity document (first page)/ identification smart card
(both sides)/ valid passport
5.4 Study permit document (for international students)
5.5 Senior/Matric certificate or equivalent/current mature
age conditional age exemption
SAQA authentication of qualifications
5.6 Certificate of registration as a Professional Nurse or
General Nurse and Midwife
5.7 Certificate of registration as a Midwife
5.8 All other additional nursing qualifications
5.9 Proof of current Professional Registration
5.10 Computer literacy /certificate
5.11 Proof of indemnity insurance
5.12 Motivation letter and confirmed study leave
5.13 Proof of yellow fever vaccination (international
applicants)

NB! Omitting the above-listed documents will result in your application being nullified.

NB! Application forms received after the closing date will not be processed.

*Shortlisted candidates will be required to undergo medical surveillance at the respective places
of employment or family doctor and will be required to submit evidence thereof, as well as
certified/original copies of some of the above documents.

DECLARATION
I have read and understood the contents of this application form. I hereby certify that all statements made
by me in this form are true and correct to the best of my knowledge. Any falsification of the information
given will lead to disciplinary measures.

Full name/s and surname of applicant:

__________________________ ________________
Applicant’s signature: Date:

GCON/postgraduate APPLICATION FORM 6

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy