Section/division: AVSEC: Training and Certifications Form Number: CA 110-02
Telephone number: 011-545-1000 Fax Number: 011-545-1458
Physical address: Ikhaya Lokundiza, 16 Treur Close, Waterfall Park, Bekker Street, Midrand, Gauteng
Postal address: Private Bag X73, Halfway House 1685 Website: [Link]
DETAILS OF BANK ACCOUNT FOR PAYMENT OF PRESCRIBED FEE
Bank: Standard Bank of SA Ltd Branch: Brooklyn, Pretoria Branch Code: 011245 Account Number: 013007971
COMPULSORY CLIENT PAYMENT CODE (to be completed on deposit slip)
Service/transaction Over the counter payments EFT, Internet, Wire, Electronic payments
Fees: See CAR Part
187.00.10
AVSEC SCREENER EXAMINATION APPLICATION
TICK THE APPROPRIATE INITIAL EXAMINATION RECERTIFICATION
A PERSONAL DETAILS
Surname
Full names
ID/passport number Nationality
Date of birth:
Postal address Postal code
Telephone number Fax number
Cell phone number E-mail
Name of present employer
Address of present employer
Postal code
Gender Race
Telephone number Fax number
Disability status Home language
B EMPLOYER DETAILS (If applicable)
Name of employer
Name of Airport/Airline/Regulated Agent/ Known
Consignor
Name of employer
Address of Employer
Postal code
Contact person/reference at place of
employment
Phone number of contact person
C SCREENING AREA/S for which you are applying
SCREENING AREA(s) METHOD OF SCREENING OBJECTIVES
State in the following page all the formal qualifications/certificates achieved in relation to the screening areas above. Attach
copies of these qualifications to your application, and mark this “Annexure A”.
CA 110-02 08 December 2022 Page 1 of 3
Name of Organisation Name of qualification Duration of course Year completed
State below the industry/technical experience you have accumulated in relation to the screening areas/qualifications above.
Attach a comprehensive CV with references to your application and clearly mark this “Annexure B”.
Name of employer Position held Period Key responsibility areas
Declaration
I ID number
Certify that the information given in the application for Examination is correct.
I hereby bind myself and am willing to adhere to the SACAA requirements for Certificated screeners.
Signed by the applicant:
Signature Date:
Witness:
Signature Date:
ALL APPLICATIONS SHOULD BE COURIERED OR POSTED TO SACAA AT THE DETAILS BELOW.
Contact person: Amanda Zamekile Twala
Telephone number: 011 545 1403 E-mail: TwalaA@[Link]
Please submit the following documents with your application
1. Certified copy of ID/passport 2. Proof of AVSEC Training including
X-Ray/CBT Report
3. CV 4. 2 X Passport size Photo/ID Photo
5. Proof of On The Job training (OJT) 6. Proof of Doctors’ Medical Fitness
7. Certified copy of Matric Certificate 8. Proof Of Payment
CA 110-02 08 December 2022 Page 2 of 2
