Pre-registration of a learner

PREMIER SECOURS CITOYEN (PSC) - the December 17, 2024

Vous pouvez vous préinscrire ou préinscrire un de vos apprenants à la formation grâce à ce formulaire.
Merci de rentrer un maximum d'informations pour simplifier le travail d'enregistrement.
Vous pouvez laisser un message complémentaire dans la partie “Notes libres”.

General information

Learner's photo

JPG, PNG or WebP, ≤ 500Ko

Honorific

First name*

Last name* Email* Date of birth*

Birth name*

Nationality*

City of birth*

County of birth*

Postcode of place of birth*

Address*

Postcode*

City*

Country*

Phone*

Secondary phone

Language in the Learners' Portal

Status

Company*

Profession

Company name*

VAT number*

Company registration number*

Other

Free notes

Information for funding agencies

Social security number

Socio-professional category

Nature of the employment contract

Gross hourly wage

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by FCSI in order to manage your registration on the site. To find out more about the management of your personal data and to exercise your rights, we invite you to read our privacy policy