Appendix B – Instructor Application – International Scaffolders Training

Section 1: Instructor Information:

Name:

First

Last

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Date of Birth:

Nationality:

Employment Status:

Directly Employed
Self Employed
On Contract
Others

Please mention your Current Employment Status:

Contact Information:

Mobile Number:

Email

Spoken Language(s):

GIST Registration Number:

Address

Address Line 1

City

State / Province / Region

Country

Section 2: Programme Applying for:

Please select the IST programme(s) you are registering for along with the copies of Shadow Certificates.

Select Programme:

Note: The IST retains the exclusive right to grant license, and this authority is solely vested in the GIST.

Please mention the Programme you are applying for:

Section 3: Applicant's Qualifications:

Please attached copies of all the mentioned qualifications copies.

Qualifications

Years of Scaffolding Experience:

(Attached Copy of Updated CV)

First Aid Qualification:

Please mention name of the course attended.

Upload CV

Click or drag a file to this area to upload.

Allowed Files: .doc, .xls, .ppt, .pdf

Upload First Aid Certificate

Click or drag a file to this area to upload.

Allowed Files: .doc, .xls, .ppt, .pdf

Teaching Qualification:

Please mention name of the course attended.

Other relevant Training(s):

Please list all other relevant training(s).

Upload Teaching Certificate:

Click or drag a file to this area to upload.

Allowed Files: .doc, .xls, .ppt, .pdf

Upload other Training(s):

Click or drag a file to this area to upload.

Allowed Files: .doc, .xls, .ppt, .pdf

Section 4: Observation Record:

Add details of the course the Applicant attended.

Observed:

Course Name:

Course Start Date:

Course End Date:

Instructor:

Add details of the Course Observed and Co-Presented with Qualified Instructor.

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Course Name:

Course Start Date:

Course End Date:

Observed By:

Add details of the course delivered under obeservation and signed off by Qualified Instructor.

Layout (copy)

Course Name:

Course Start Date:

Course End Date:

Observed By:

Upload Observation Report:

Click or drag a file to this area to upload.

Section 5: Details of the Training Facility:

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Registration Number:

Registered Name:

Section 6: Declaration:

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Applicant's Name:

Signature Date:

Signature:

Training Centre Contact Name:

Signature Date:

Signature: