CHW Application APPLICATION FORM-2017 KAPUNA COMMUNITY HEALTH WORKER TRAINING SCHOOL Please be sure to answer all sections of this form as honestly and carefully as possible.ImagePersonal DetailsGiven Name*Age/Date of BirthSurnameGenderVillageMarital StatusSingleMarriedProvinceNumber of ChildrenPlease enter a number from 0 to 10.ChurchState if you are disableContact AddressMobileEmail PhoneEDUCATION QUALIFICATIONGrade Ten Certificate (Gr 10) Subjects ResultsEnglishMathematicsScienceSocial ScienceGrade Twelve (Gr 12) Subjects ResultsEnglishMaths A/BChemistryBiologyGeneral Questions1. What did you write as first preference on your School Leaver’s Form?2. What was your second preference?3. What other courses have you applied to apart from CHW Training?a. If so what training?Previous Employment?4. Have you been employed in any jobs since you left school?a. If so what job?b. How long were you employed?b. How long were you employed?c. Why did you leave?5. Are your parents happy for you to do CHW Training?6. Write briefly what being a Christian means to you.7. Have you made a commitment to follow Christ?8. If you are selected as a CHW Trainee, what would you do if you didn’t agree with some of Kapuna rules?9. Your friend as a relationship with someone of the opposite sex in their first year of training which is against the rules and you know about it. What would you do10. What would you do as if as a CHW, after finishing your training, you could not get a job in your province?11. What would you do if as a CHW, the government cut your salary from say, K400 per fortnight to K200 per fortnight?Please send this completed application form to the Kapuna CHW School Principal before 31st August. An initial selection list will be made and all those listed will be required to sit an entry test at a designated location closest to them. Those who successfully pass the test will officially receive an acceptance letter or email. Successful applicants are expected to receive an official acceptance letter in December. Requirement: You must send with this application form the following items. • Application fee of K20.00 • If you have completed both grade 10 and 12, please send photocopies of your certificates. • A reference from your school teacher/headmaster or recent employer • A reference from a Christian leader who knows you well. (The reference must not be written by person related to you. Reference can be either typed or handwritten). • Married students are considered with the approval letter from their partner (husband or wife) and witnessed by Pastor or Church Elder. • If you are sending your application through email, make sure pay application fee of K20.00 through ANZ Bank Acc No 1114586 Acc Name CHW Training School Kapuna Branch down Town Port Moresby. Email the application form with the application fee receipt of K20.00Note: Seventh Day Adventist Applicants/PNG Revival Applicants:Are you prepare to fully take part in training school and Christian activities on every day of the week?Note: If your references or certificates have been altered, or not written by the right person or belong to others, we will consider cheating and your application will not be considered. If you know that you have a fails on your certificate. Please do not apply. Those accepted must bring their original certificate with 80% upfront school fee receipt. If you live away from Kapuna then send your application on the above address given. For nearby applicants can hand deliver their applications and other necessary documents to the Kapuna CHW Training Office?Note To All: UNLESS YOU RECEIVE AN OFFICIAL ACCEPTANCE LETTER FROM THE SCHOOL THEN YOU ARE NOT ACCEPTED. ANY APPLICANT WHO TRAVELS TO KAPUNA WITHOUT AN ACCEPTANCE LETTER OR EMAIL WILL HAVE TO FIND HIS/HER OWN WAY HOME. THE SCHOOL WILL NOT TAKE RESPONSIBILTY FOR ANY APPLICANT WHO TRAVELS WITHOUT AN ACCEPTANCE LETTER.
