Doc No: GWG-CP-FRM-CEF-003

PART A

FULL NAME:

Candidate Evaluation Form

Green World Safety and Security Green World International Training Green World Management
Consultancies LLC Center Consultants & Training Institute
Suite # 102 First Floor, Suite No: # 613, Business Tower Old No 598 B, New No 828,
Sapphire Tower, Near Dnata, #101 King Abdul-Aziz Street, Jubail Poonamallee High Road, Arumbakkam,
Deira, Dubai Po Box: 83127 city, Kingdom of Saudi Arabia Chennai – 600 106

Telephone: (+971 4) 2698807 Telephone: (+966 13) 3638442 Telephone: (+91 44) 48561333
Mobile: (+971) 557044902 Mobile: (+966 50) 5744 304 Mobile: (+91) 8098498158
E-mail: info @greenwgroup.com E-mail: info.saudi@greenwgroup.com E-mail: info.india@greenworldsafety.com

1. PERSONAL DETAILS

Family Name: ............................................................................................................................................................................

First / Given Name(s) ................................................................................................................................................................

Title (Mr / Mrs / Miss / Ms etc): ........................................

Main Contact Address ..................................................... Home Address (if different) ................................................

............................................................................................ ................................................................................................

............................................................................................ ................................................................................................

......................................... Country ................................... .............................................. Country ..................................

Main Contact Telephone Number: .........................................................................................................................................

(Including Country Code)

Home Telephone Number (if different): ..................................................................................................................................

Email Address .................................................................. Mobile Number ...................................................................

(Including Country Code)

SEX: Date of Birth: (e.g. 15.03.1972)

Male (M) Day Month Year

Female (F)

DISABILITY/SPECIAL NEEDS

If you have a disability / special need and may require extra support during the course of study, please enter in the
box the type of disability.

Please give details of any disability and indicate clearly what needs you have ................................................................

........................................................................................................................................................................................................

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2. FURTHER DETAILS

Nationality: ....................................................................... Country of Permanent Residence: .....................................

Country of Birth: .............................................................. Residential Category: .........................................

Who will be paying your course fees? (Please give full name and address) ..................................................................

............................................................................................................................. .......................................................................

3. DETAILS OF COURSE(S) TO WHICH YOU WISH TO APPLY

NEBOSH Courses:

NEBOSH HSW NEBOSH IGC NEBOSH PSM

NEBOSH Incident Investigation NEBOSH IDip.

Please indicate how you heard of these courses:

4. WORK EXPERIENCE

Part time / From To

Employer Name / Training Body Type of Business Your Job Title Full time Month Year Month Year

5A QUALIFICATIONS GAINED:

English Language Qualification: Please indicate TOEFL / CBT Score

Qualifications IELTS Score
Other:
(please specify)

Duration / Date Mode of Study

Name of Qualification (Number of (full time / part Subject(s) Result Place of Study
months / years) time)

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5B QUALIFICATIONS FOR WHICH YOU ARE CURRENTLY STUDYING:

Duration / Date Mode of Study

Name of Qualification (Number of (full time / part Subject(s) Result Place of Study
months / years) time) expected /
predicted

Have you previously studied in Green World Group? YES / NO

If yes, please give brief details (e.g. course, dates of study, student number)

6. ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION:

PERSONAL STATEMENT
Reasons for applying for course /
subject

Details of relevant work

experience

Special interests / Career

aspirations

Other relevant
information

Do you have any criminal Yes No

convictions?

7. NAME(S) AND ADDRESS(ES) OF REFEREE(S):

1. 2.

Telephone number: Telephone number:

Mobile number: Mobile number:
E-mail address: E-mail address:

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8. SOMETHING SOCIAL ABOUT YOU. (Please note that this is as part of a student evaluation process to better understand
about your approach to doing any course)

1. Tell me something about your Family and Friends.

(Like Married / Number of Children / Number of Friends etc.)

2. How do you like to spend your holidays / weekends?

3. What are your hobbies?

9. DECLARATION

I confirm that the information given on this form is true, complete and accurate and no information requested or
other material information has been omitted. I understand that the information provided by the training provider
with the Data Protection Act (the Act) and I give my express consent to the processing of my personal sensitive
data as defined by the Regulation of Green World Group training center. I have read the Notes for Guidance and
I undertake to be bound by them. I undertake to pay or cause to the Green World Group Training Center by the
due date.

Applicant’s Signature ............................................................................. Date: ........................................................

FOR OFFICE USE ONLY

It is hereby confirmed that based on the student information provided above, he/she meets the minimum
requirement of English Language understanding with the below findings:

Read Very Poor ☐ Poor ☐ Fair ☐ Good ☐ Very Good ☐

Write Very Poor ☐ Poor ☐ Fair ☐ Good ☐ Very Good ☐

Speak Very Poor ☐ Poor ☐ Fair ☐ Good ☐ Very Good ☐

The student has therefore qualified to enroll for the course ………………………………………………………….....

…………………………………………………………………………………………………………………………………..
and proceed to Student Registration (Part B form)

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