WP Rugby Referees

Application Form for Juniors

Personal Details

First Name

Last Name

Why do we ask?

Date of Birth:

Identification:

ID Number
Passport Number

ID Number:

Contact Information

Next of Kin Contact Information:

Education

Physical Address

Province:

Banking Details:

Cardholder Name:

Name of Bank:

Branch Code:

Account Type:

Account Number:

Proof of Account:

Upload Proof of Account (PDF, JPG, PNG):

BokSmart

BokSmart Expiry Date:

Have you completed a 'World Rugby Level 1' course?

Yes No

Have you refereed before?

Yes No

By submitting this form, you certify that the information contained herein is true and correct as well as the following:

I hereby undertake to be a devoted and disciplined member of the Society and to subject myself to the Constitution and Bye-laws of the Society as legally amended from time to time.

I have read and agree to the above information

Personal Details

First Name

Last Name

Why do we ask?

Date of Birth:

Identification:

ID Number
Passport Number

ID Number:

Referee Experience

Level (e.g., School, Club, Provincial)

Years Experience

Rugby Association

Approx. Matches Officiated

Occupation & Availability

General Availability:

Weekdays Weekends Both Flexible

Are you prepared to referee anywhere in Western Province?

Yes No

Transportation

Public Transport

Private Transport

Qualifications

BokSmart Number

Have you completed a World Rugby Level 1 course?

Yes No

World Rugby Referee Level:

Level 1 Level 2

Other Certifications

Certification Name

Year Obtained

Banking Details:

Cardholder Name:

Name of Bank:

Branch Code:

Account Type:

Account Number:

Proof of Account:

Upload Proof of Account (PDF, JPG, PNG):

Contact Information:

Your Contact Number

Repeat Contact Number

Your E-Mail Address

Repeat Your E-Mail Address

Declaration

By submitting this form, you certify that the information contained herein is true and correct.

I hereby undertake to be a devoted and disciplined member of the Society and to subject myself to the Constitution and Bye-laws of the Society as legally amended from time to time.

I agree to abide by the Society's Code of Conduct and understand that failure to do so may result in disciplinary action.

I have read and agree to the above terms

There is a process to follow before taking charge of your first game, they are:

Complete the application form and submit proof of payment of the R250 fee. The bank details are on the application form.
There are several courses that need to be completed first:

As you successfully complete each course the system will generate an electronic certificate which you can download and save.

Send copies of these certificates to:

recruitmentrefs@wprugby.co.za
fsaid@wprugby.co.za
btheron@wprugby.co.za

REACH YOUR FULL

POTENTIAL

BECOME A

REFEREE

APPLY NOW

Application Form for Juniors

Personal Details

Identification:

Contact Information

Next of Kin Contact Information:

Education

Physical Address

Banking Details:

Proof of Account:

BokSmart

Application Form for Seniors

Personal Details

Identification:

Referee Experience

Occupation & Availability

Transportation

Qualifications

Other Certifications

Banking Details:

Proof of Account:

Contact Information:

Declaration

WHY NOT BECOME A REFEREE?

WHAT DO I NEED TO DO?

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