S A Council for Social Service Professions SACSSP

Transcription

1 S A Council for Social Service Professions SACSSP Private Bag X12, Gezina, Annie Botha Ave, Riviera, Pretoria, 0084 Tel: (012) Fax: (012) Inq: Ref: mail@sacssp.co.za APPLICATION FOR REGISTRATION AS A SOCIAL AUXILIARY WORKER THIS APPLICATION FORM MUST BE COMPLETED PERSONALLY BY THE APPLICANT IN PRINT OR TYPING. Study the application form carefully before completing it. Answer all questions fully, clearly and correctly. Questions which do not apply to you, must be clearly deleted. Should you have to make any corrections to your answers, initial them in the margin. PLEASE NOTE: The documentary proof of payment and documents as prescribed on page 2 of the application form must accompany the application form to avoid delay of the processing of your registration. 1. PERSONAL PARTICULARS 1.1 Title: Mr Mrs Miss Ms Other 1.2 Surname: 1.3 Maiden name: 1.4 Full first names (Additional initials of names not mentioned herein but on Identity Document) 2. PLEASE NOTE: This application must be accompanied by the following 2.1 A certified copy of documentary proof of your names, identity or residence permit number and date of birth or age, acceptable to the Council. 2.2 A certified copy of the marriage certificate of women who are or were married. 2.3 A certified copy of documentary proof of the qualification(s) (on the basis of which you apply for registration, that is - 1

2 2.3.1 the highest school standard which you have passed; the Certificates in Social Auxiliary Work which you have obtained from the training institution and HWSETA (Certified copies); or another degree/diploma/certificate which you have obtained and which you wish to submit to the Council for evaluation to determine whether it is equal to or higher than the qualification referred to in paragraph An ORIGINAL copy of documentary proof (ACADEMIC RECORD) issued by the training institution illustrating the content of the learning program of the qualification stipulated in above in which an indication is given of all the subjects/modules you have passed and the duration of the course in each subject An ORIGINAL copy of documentary proof (QUALIFICATION TITLE) issued by HWSETA 2.5 If your qualification(s) was/were obtained outside the R S A, also a certified copy of documentary proof from the training institution where you received education and training in Social Auxiliary Work, in whatever way it may have been referred to, of the content of theoretical education and both the nature and duration of field instruction you received in each subject; and documentary proof that the qualification(s) is/are or was/were the accepted education and training for social auxiliary work, in whatever way it was referred to, in the country concerned Portfolio of evidence Assignments as prescribed by the SACSSP 2.6 If you apply for registration on the basis that you were employed as a social auxiliary worker, in whatever way you were referred to, before 15 November 1991, you must submit documentary proof acceptable to the Council in which your employer certifies the following: The date on which you were employed The official title of the post you hold The nature of the work you do and the manner in which it relates to social work services. 2.7 A written undertaking from your employer specifying the following: The fact that you will be supervised by a registered social worker The nature, content and duration of the supervision The fact that the social worker supervising you is aware of the fact that he/she is legally co-responsible for your acts as a social auxiliary worker The official title of the post you hold. 2.8 Any document that must accompany this application and that is not drawn up in English or Afrikaans shall be accompanied by a translation prepared by a sworn translator in English or Afrikaans, as well as a certified copy of the original document, and the onus shall be on you to have such document so translated. 2.9 A copy of the bank deposit or proof of electronic/internet transfer as proof of payment to the value of the prescribed registration fee. 3. The Council may order that an evaluation interview be conducted with applicants who obtained other qualification(s) than the qualifications referred to in paragraph POST your application to the Registrar, SACSSP, Private Bag X 12, Gezina, Pretoria, REGISTRATION PARTICULARS 5.1 Have you previously applied for registration as a social auxiliary worker with this Council? Yes No 5.2 If yes, what was the result? Approved Rejected Incomplete 5.3 If approved, state if you were registered as social auxiliary worker Yes No If yes, registration number as a social auxiliary worker (see registration certificate): 50-2

3 5.3.2 pupil social auxiliary worker: Yes No If yes, registration number as pupil social auxiliary worker (see registration certificate): N student social worker Yes No If yes, registration number as student social worker (see registration certificate): social worker Yes No If yes, registration number as social worker (see registration certificate): Language preferred Afrikaans English 5.5 Identity or residence permit number 5.6 Date of birth: Y M D Gender: - - Male Female 5.7 Marital status:1 Never married 2 Married 3 Divorced Widow/Widower 1. White 2. Coloured 3. Black 4. Indian 5. Other 5.9 Residential address: Postal code:... Tel Nr where you can be reached during the day (code and number):... Mobile number:, address: 5.10 Postal address: 3

4 Postal code: Name and address of employer: Postal code:... Tel Nr (code and number): Date of commencement of employment as a Y M D social auxiliary worker with present employer: 5.13 Present official title:... (Eg. Social Auxiliary Worker) 6. TRAINING INSTITUTION WHERE YOU OBTAINED YOUR BASIC (PRE- REGISTRATION) QUALIFICATION(S) IN SOCIAL AUXILIARY WORK 6.1 Training institution in the R S A: Name of the training institution: Address of the training institution: Postal code: Training institution outside the R S A: Country 4

5 6.2.2 Name of training institution: 7. PARTICULARS OF BASIC (PRE-REGISTRATION) QUALIFICATION(S)* 7.1 Scholastic qualification (state highest school standard passed): Post scholastic 1 Degree 2 Diploma 3 Certificate in Social qualification: Auxiliary Work Duration of course: 1y 2y 3y Other:... (Specify) Date on which you initially registered as a student for this qualification: Y M D Name of qualification: Date on which this qualification was conferred upon you: Y M D Subjects (passed with a view to obtaining the qualification referred to in paragraph 7.2): Name of subject Duration of course (in years) 8. PARTICULARS OF ADDITIONAL (POST-BASIC) QUALIFICATION(S) IN SOCIAL AUXILIARY WORK* Qualification Training institution Date conferred upon you 5

6 9. PARTICULARS OF QUALIFICATION(S) IN OTHER FIELDS OF STUDY WHICH YOU POSSESS* Qualification Training institution Date conferred upon you *PLEASE NOTE: Certified copies of documentary proof of the qualifications referred to in paragraphs 7, 8 and 9 must be attached in order to be entered into the Register. 10. GENERAL QUESTIONS 10.1 Have you ever been found guilty of unprofessional or improper conduct by this Council? 10.2 If yes - Yes No were you reprimanded or cautioned? Yes No was your registration cancelled? Yes No was your registration suspended? Yes No was the imposition of a penalty postponed? Yes No was the execution of your penalty suspended? Yes No 10.3 Have you ever been found guilty of an offence by a court of law? Yes No 10.4 If yes, specify the nature of the offence of which you were convicted and the sentence passed: 10.5 Are any legal steps pending against you at present? Yes No 10.5 If yes, specify what steps: DISCLOSURE OF CRIMINAL OFFENCES: Training institutions to inform the Council of the outcomes of any criminal offence that led to a disciplinary hearing which the person was found guilty and convicted I, the undersigned, declare that the information furnished in this application form is true and correct in all respects and that I am unaware of anything which would serve as an impediment to my registration as a social auxiliary worker/the restoration of my name to the Register for Social Auxiliary Workers. Signed at... on this... day of SIGNATURE OF APPLICANT: 6

7 S A Council for Social Service Professions SACSSP Private Bag X12, Gezina, Annie Botha Ave, Riviera, Pretoria, 0084 Tel: (012) Fax: (012) Inq: Ref: mail@sacssp.co.za UNDERTAKING FROM EMPLOYER (2.7 on the application form) I (Full names and surname) hereby declare that. (Name of organization) Undertake that: (a) the social auxiliary worker. (names) in the employ of the above-mentioned organization will work under the guidance and management(supervision) of a registered social worker. (b) the social worker supervising the social auxiliary worker is aware of the fact that he/she is legally co-responsible for the acts of the social auxiliary worker when performing his/her duties as social auxiliary worker. Address of employer/organization: Tel.No.:.. Fax No.: Particulars of supervisor/social worker: Tel.No.: Fax No.: SACSSP Reg. No: Signature: Employer:.. Signature of Supervisor:.. Date:... Date:... Official stamp of organisation: We, the above signed, declare that the information furnished in this application form is true and correct in all respects and that I am unaware of anything which would serve as an impediment to the supervision of the learner in question. 7

8 FEES PAYABLE FEES TO BE PAID BY APPLICANT: Outstanding Student Registration fee: - Social Worker Registration fee: R Annual Fee 2014/2015 R TOTAL TO BE PAID: R NB: ALL COSTS ARE SUBJECT TO CHANGE WITHOUT PRIOR NOTICE N.B.: 1. SEE PAGE 1 & 2 OF THE APPLICATION FORM FOR DOCUMENTS TO BE SUBMITTED TOGETHER WITH THE APPLICATION. 2. USE YOUR COUNCIL REGISTRATION NUMBER (40-...), FULL NAMES AND SURNAME AS DEPOSIT REFERENCE ON THE BANK DEPOSIT SLIP. 3. BANK DETAILS: BANK: ABSA (ONLY) ACCOUNT NO BRANCH: HATFIELD BRANCH CODE: SEND A CLEAR COPY OF THE DEPOSIT SLIP TOGETHER WITH THE APPLICATION FORM AND PRESCRIBE DOCUMENTS. **DO NOT FAX THIS APPLICATION FORM!! 8