{"id":218,"date":"2023-06-07T22:08:52","date_gmt":"2023-06-07T22:08:52","guid":{"rendered":"https:\/\/sinafoundation.co.za\/?page_id=218"},"modified":"2023-06-13T15:21:49","modified_gmt":"2023-06-13T15:21:49","slug":"beneficiary-assessment-form","status":"publish","type":"page","link":"https:\/\/sinafoundation.co.za\/?page_id=218","title":{"rendered":"Beneficiary Assessment Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"218\" class=\"elementor elementor-218\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-004e21f elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"004e21f\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-06628ce\" data-id=\"06628ce\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cc0a78d elementor-widget elementor-widget-heading\" data-id=\"cc0a78d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">BENEFICIARY ASSESSMENT <br>FORM<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-96ef4c1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"96ef4c1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a56e135\" data-id=\"a56e135\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-0e3eacd elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0e3eacd\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-bea4378\" data-id=\"bea4378\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-31af1a1 eael-contact-form-7-button-align-left eael-contact-form-7-button-custom elementor-widget elementor-widget-eael-contact-form-7\" data-id=\"31af1a1\" data-element_type=\"widget\" data-widget_type=\"eael-contact-form-7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"eael-contact-form-7-wrapper\">\n                <div class=\"eael-contact-form eael-contact-form-7 eael-contact-form-31af1a1 placeholder-show eael-contact-form-align-default\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f234-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F218#wpcf7-f234-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"234\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f234-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"uacf7-form-234\"><div class=\"clearfix\">\n    <div class=\"Sec prt1\">\n    <h2>1. PERSONAL DETAILS<\/h2>\n        <div id=\"left\">\n            <p class=\"ques\">First name &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Email &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">ID Number &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"id-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"id-number\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Residential Address &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"res-area\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"res-area\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Current Employment Status &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-0\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-0\" value=\"Unemployed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Unemployed<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-0\" value=\"Part-time\" \/><span class=\"wpcf7-list-item-label\">Part-time<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-0\" value=\"Full-time\" \/><span class=\"wpcf7-list-item-label\">Full-time<\/span><\/span><\/span><\/span><\/p> <br\/>\n            <p class=\"ques\">Place of Birth &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"birth-place\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-place\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Gender &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-1\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-1\" value=\"Male\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-1\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/span><\/span><\/span><\/p> <br\/>\n            <p class=\"ques\">Marital Status &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-2\" value=\"Single\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Single<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-2\" value=\"Married\" \/><span class=\"wpcf7-list-item-label\">Married<\/span><\/span><\/span><\/span><\/p> <br\/>\n            <p class=\"ques\">Contact Number &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone\" \/><\/span> <br\/><\/p>\n            <p class=\"ques\">Alternative Number &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Age Group &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-3\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-3\" value=\"&gt;18 Years\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">&gt;18 Years<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-3\" value=\"&lt;18-35 Years\" \/><span class=\"wpcf7-list-item-label\">&lt;18-35 Years<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-3\" value=\"&lt;35-50 Years\" \/><span class=\"wpcf7-list-item-label\">&lt;35-50 Years<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-3\" value=\"&lt;50-65 Years\" \/><span class=\"wpcf7-list-item-label\">&lt;50-65 Years<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-3\" value=\"&lt;65 Years\" \/><span class=\"wpcf7-list-item-label\">&lt;65 Years<\/span><\/span><\/span><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you directly linked to a domestic worker? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-4\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-4\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-4\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/p> <br\/>\n            <p class=\"ques\">Contact Name of Domestic Worker &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"dome-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dome-name\" \/><\/span><\/p> <br\/>\n        <\/div><br\/>\n        <div id=\"right\">\n            <p class=\"ques\">Last Name &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Citizenship &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Work Address &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"work-area\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"work-area\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Number of People In the Household &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"no-house\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"no-house\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Number of Children &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"no-child\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"no-child\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Do you have any formal education? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-5\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-5\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-5\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/p> <br\/>\n            <p class=\"ques\">Highest Standard\/ Level Passed\/ Completed &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"edu\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"edu\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Year of completion &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"year-edu\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"year-edu\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Name of Institution &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"eduschoo-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"eduschoo-name\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Contact Number of Domestic Worker &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone-dome\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone-dome\" \/><\/span><\/p> <br\/>\n            <p class=\"ques\">Relationship with the Domestic Worker &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"dome-rel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dome-rel\" \/><\/span><\/p> <br\/>\n        <\/div><br\/>\n    <\/div><br\/>\n<\/div>\n<div class=\"clearfix\">\n    <div class=\"Sec prt2\">\n        <h2>2. Area of Support<\/h2>\n            <p class=\"ques\">Human Rights &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-6\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-6\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-6\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hum-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hum-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Education and Skilling &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-7\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-7\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-7\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Healthcare &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-8\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-8\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-8\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hea-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hea-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Welfare &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-9\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-9\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-9\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n    <\/div><br\/>\n<\/div>\n<!--nextpage-->\n<div class=\"clearfix\">\n    <div class=\"Sec prt3\">\n        <h2>3. Needs Assessment<\/h2><br\/>\n            <h3>3.1. Human Rights<\/h3><br\/>\n            <p class=\"ques\">Are you aware of your rights as a domestic worker? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-10\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-10\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-10\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hum-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hum-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you in possession of a Letter of Appointment? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-11\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-11\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-11\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you registered for Unemployment Insurance Fund? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-12\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-12\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-12\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hea-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hea-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Is your employer contributing for Workmen\u2019s Compensation on your behalf? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-13\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-13\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-13\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you satisfied with you current Conditions of Employment? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-14\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-14\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-14\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you satisfied with your Employer\u2019s treatment in your workplace? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-15\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-15\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-15\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Have you experienced any human rights violation in your workplace? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-16\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-16\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-16\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">General Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n    <\/div><br\/>\n<\/div>\n<div class=\"clearfix\">\n    <div class=\"Sec prt4\">\n            <h3>3.2.Education and Skilling<\/h3><br\/>\n            <p class=\"ques\">Do you have any special skills that may  assist you with generating extra income? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-17\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-17\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-17\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hum-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hum-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you interested in acquiring any new  skills (over a period of 3-18 months) that may  assist you with generating extra income? &nbsp;[radio-18 \"Yes\" \"No\"] &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you interested in starting your own  business and\/or partnering with others to  form business? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-19\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-19\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-19\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hea-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hea-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">General Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n    <\/div><br\/>\n<\/div>\n<div class=\"clearfix\">\n    <div class=\"Sec prt5\">\n            <h3>3.3. Healthcare<\/h3><br\/>\n            <p class=\"ques\">Do you have any health conditions  requiring frequent access to health care  services\/facilities?  &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-20\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-20\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-20\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hum-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hum-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you able to access health care  facilities to obtain necessary health care  assistance? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-21\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-21\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-21\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">General Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n    <\/div><br\/>\n<\/div>\n<div class=\"clearfix\">\n    <div class=\"Sec prt6\">\n            <h3>3.4. Welfare<\/h3><br\/>\n            <p class=\"ques\">Do you have any source of income?  &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-22\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-22\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-22\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"hum-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"hum-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Do you regard your living conditions as  being sustainable? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-23\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-23\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-23\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you able to secure a meal\/s on daily  basis? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-24\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-24\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-24\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Do you require any special care and  support? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-25\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-25\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-25\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are you under anyone\u2019s care and\/or  guardianship? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-26\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-26\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-26\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">Are there any vulnerable minors under  your care? &nbsp;<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-27\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-27\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-27\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span> &nbsp;&nbsp; Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"edu-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea sideremark\" aria-invalid=\"false\" name=\"edu-sup\"><\/textarea><\/span><\/p> <br\/>\n            <p class=\"ques\">General Remarks &nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"wel-sup\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"wel-sup\"><\/textarea><\/span><\/p> <br\/>\n    <\/div><br\/>\n    <p class=\"ques\">By clicking the \"I Agree\" button below, I, acknowledge that I consent to undergo a Needs Assessment conducted by SINA Foundation. I understand that this assessment is not a commitment or agreement between myself and SINA Foundation.\n\n        I also acknowledge that, should I be deemed eligible for any assistance, I will enter into an Enrollment Agreement with SINA Foundation and will be bound by the Terms and Conditions set out therein.<br\/>\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-28\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"I agree\" \/><span class=\"wpcf7-list-item-label\">I agree<\/span><\/span><\/span><\/span> <br\/>\n        <input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n    <\/p>\n<\/div><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n            <\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>BENEFICIARY ASSESSMENT FORM 1. PERSONAL DETAILS First name &nbsp; Email &nbsp; ID Number &nbsp; Residential Address &nbsp; Current Employment Status &nbsp;UnemployedPart-timeFull-time Place of Birth &nbsp; Gender &nbsp;MaleFemale Marital Status &nbsp;SingleMarried Contact Number &nbsp; Alternative Number &nbsp; Age Group &nbsp;&gt;18 Years&lt;18-35 Years&lt;35-50 Years&lt;50-65 Years&lt;65 Years Are you directly linked to a domestic worker? &nbsp;YesNo Contact Name [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-218","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=\/wp\/v2\/pages\/218","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=218"}],"version-history":[{"count":19,"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=\/wp\/v2\/pages\/218\/revisions"}],"predecessor-version":[{"id":265,"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=\/wp\/v2\/pages\/218\/revisions\/265"}],"wp:attachment":[{"href":"https:\/\/sinafoundation.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=218"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}