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APPLICATION FORM
(NON-REFUNDABLE APPLICATION FEE OF JA$2,000)

Section 1 - Application Form

I hereby apply for the following Programme at Health, Education and Counselling Institute, HECOIN:  International Diplomas in Health Care, Practical Nursing and Phlebotomy or HECOIN Diplomas in Emergency Medical Services/Emergency Medical Technician and Mental Health.
 
Phlebotomy (4 months) January September November  
Health Care (12 months) 2013        
Practical Nursing, LPN (24 months)
EMT/EMS (6 months)
Mental Health (4 months)
Home Health Aide/HHA
Campus Location (Kingston, Portmore, Spanish Town, Mandeville, Ocho Rios and Montego Bay)

LEGAL NAME (Name to appear on all documents - Foreign Countries and Jamaica)

First Name:
Middle Name:
Surname:
TRN Number:
Gender:

 
Date of Birth:
Marital Status
Total Dependents
(Dependents mean persons who have to rely on you to survive)
 
Occupation:
Mailing Address:
Telephone (876): (HOME)
Telephone (876): (CELL)
Email Address:

District & Parish of Birth:

Name & Address of Medical Practitioner:
 

Do you have any allergies, disability or serious medical condition?

If yes, please specify:

Next of Kin:

Relationship:

Contact (Cell):

Have you or any close member of your family committed a crime, been arrested or charged with any criminal offence in any country?

 

If yes, please specify:
Section 2 - Education
  From: To:    
  From: To:    
  From: To:    
  From: To:    
  From: To:    
  From: To:    
 
Please list all your qualification results
Governing / Examining Body: Subjects / Certificates: Year:   Grade:  
   
   
   
   
   
   
   
           
Have you ever done a Practical Nursing programme before?    
If yes, please specify name, address and telephone numbers of the institution.  
Name of Institution:        
Address:        
Telephone (876):        
           
What level of certification did you attain at that Institution?    
Section 3 - Employment History
List names, addresses and telephone numbers of last two (2) places of employment:
Name of organization: Name of organization:
Address: Address:
Telephone (876): Telephone (876):
Position held: Position held:
Section 4 - Applicant's Statement
(If you agree with each of the following clauses, please tick the corresponding box)
It is my undestanding that:

1.

I must complete all questions on the application form (whether typed or printed), in black or blue ink without the use of correction fluid/white-out.

2.

 I must sign the application form using my full legal name in the presence of the HECOIN office staff.

3.

 If my school fees are not paid in time, this may prevent me from completing the programme requirements at the stated time.

4.

I must attend at least one interview prior to the commencement of classes; one with the Director of Administration, Finance and Marketing and/or the other with an interview panel consisting of the Principal or her designate.  If the panel finds me to be an unsuitable candidate, then I will be denied the opportunity to join to be a student in the Health Care programme at the HECOIN.

5.

 I must take 3 original 2” x 2” photographs and affix my name to the back along with my TRN, along with a certified copy of birth certificate and certified copies of exam results.

6.

This programme facilitates training only.  Upon successfully completing this programme, the student is responsible for contacting the school’s Immigration Consultant in an effort to secure job and work permit for any Commonwealth country.

7.

 I must submit a medical report and two (2) character references (one from last school);

8.

 If there is behavior of any kind/sort which the institution deems inappropriate, I will be asked to immediately discontinue/leave the programme and will not be entitled to any refund.  The decision of the Principal and Director of Admin, Finance and Marketing is final.

9.

 If the recommendations/references do not meet the required standard of HECOIN, I will not be accepted in the programme.

10.

 If I receive less than 70% in any test/assignment, this may prevent me from continuing in the programme.  Students who fail will not be entitled to a refund of any sort.

11.

Students must attend 90% of classes and all practicum and clinical sessions.

12.

All students must wear full uniform to classes and lab coat at practicum and clinical sites.

13.

 HECOIN will retain a fee called "admin fee" of JA$5,000 for persons who pay/make a down payment on school/tuition fee but request a refund before commencement of classes.

14.

 HECOIN will allow refund up to the end of the 2nd week of classes of the admin fee + rebated fee for classes.  The date used for this procedure will be the date that the written refund was handed to the office.

15.

Refund cheques take up to 4-6 business days.
On completion of successful interview/s:

16.

 I must hand in a criminal record obtained from the Jamaica Constabulary Force; for persons wishing to work overseas

17.

 I must submit a detailed bill of health from an approved Medical Practitioner.  Students must present a copy of an up-to-date immunization card.  If it is not up-to-date, students will be required to get Hepatitis B injection during the 4th/5th week of classes

18.

If I refuse to tick any of the clauses above (in this category), then I will be deemed unfit for the programme.

19.

Completion of the programme does not necessarily guarantee or assure that students completing the training under this agreement will be admitted to work overseas. Successful completion means *maintain 70% for all tests and assignments, including Practicum and Clinical grades, *clean bill of health, *clean criminal record, *no disciplinary problem at HECOIN, *90% attendance for classes, *good personality, *good attitude, *good oral and *verbal communication skills.  HECOIN is responsible for training only.
   
           

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