Alcolizer Training - Client Information Form

Are you an existing Alcolizer account holder? *

Yes - I have a quote or purchase order number
No - please quote for me!
I'm not sure

Quote/Purchase Order number #

A purchase order number or a quote number supplied to you by an Alcolizer representative.

If you're not sure, please provide any information that will help us create your training (quote number or name of an Alcolizer contact).

Contact details

Is the training for your company or for yourself? Please select from the two options below: *

Company
Personal/Self

Contact details

Company Name *

Please enter the name of your company

Name *

Position *

Email *

Email

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please provide the work site where the training will occur.

When is the training required? Note: we require up to 24 hours to action enrolments. *

Course and Trainee details

How many trainees do you require? *

1-5
more than 5

Step 1. Download the excel sheet
Download the excel sheet template in the link below and fill in with trainee details:

http://bit.ly/newtrainees

Step 2. Trainee Sheet Upload *

Trainee #1 Name *

First

Last

Trainee #1 Email *

South African ID (for South African citizens only)

Select from the following online courses:

HH3 Alcohol Tester Familiarisation
LE5 Alcohol Tester Familiarisation
HH3 Alcohol Tester Certified Operator
LE5 Alcohol Tester Certified Operator
HH4 Alcohol Tester Certified Operator
LE5 Drug Tester Certified Operator
Reasonable Suspicion Training
Certified Specimen Screening Officer Online Training (HLTPAT005)
AlcoCONNECT mobile Familiarisation

Add trainee 2

+ Add another trainee

Trainee #2 Name

First

Last

Trainee #2 Email *

South African ID (for South African citizens only):

Select from the following online courses:

HH3 Alcohol Tester Familiarisation
LE5 Alcohol Tester Familiarisation
HH3 Alcohol Tester Certified Operator
LE5 Alcohol Tester Certified Operator
HH4 Alcohol Tester Certified Operator
LE5 Drug Tester Certified Operator
Reasonable Suspicion Testing Training
Certified Specimen Screening Officer Online Training (HLTPAT005)
AlcoCONNECT mobile Familiarisation

Add trainee 3

+ Add another trainee

Trainee #3 Name

First

Last

Trainee #3 Email *

South African ID (for South African citizens only):

Select from the following online courses:

HH3 Alcohol Tester Familiarisation
LE5 Alcohol Tester Familiarisation
HH3 Alcohol Tester Certified Operator
LE5 Alcohol Tester Certified Operator
HH4 Alcohol Tester Certified Operator
LE5 Drug Tester Certified Operator
Reasonable Suspicion Testing Training
Certified Specimen Screening Officer Online Training (HLTPAT005)
AlcoCONNECT mobile Familiarisation

Add trainee 4

+ Add another trainee

Trainee #4 Name

First

Last

Trainee #4 Email *

South African ID (for South African citizens only):

Select from the following online courses:

HH3 Alcohol Tester Familiarisation
LE5 Alcohol Tester Familiarisation
HH3 Alcohol Tester Certified Operator
LE5 Alcohol Tester Certified Operator
HH4 Alcohol Tester Certified Operator
LE5 Drug Tester Certified Operator
Reasonable Suspicion Testing Training
Certified Specimen Screening Officer Online Training (HLTPAT005)
AlcoCONNECT mobile Familiarisation

Add trainee 5

+ Add another trainee

Trainee #5

First

Last

Trainee #5 Email *

South African ID (for South African citizens only):

Select from the following courses:

HH3 Alcohol Tester Familiarisation
LE5 Alcohol Tester Familiarisation
HH3 Alcohol Tester Certified Operator
LE5 Alcohol Tester Certified Operator
HH4 Alcohol Tester Certified Operator
LE5 Drug Tester Certified Operator
Reasonable Suspicion Testing Training
Certified Specimen Screening Officer Online Training (HLTPAT005)
AlcoCONNECT mobile Familiarisation

Alcolizer Training – Client Information Form

Contact details

Contact details

Course and Trainee details