Personal Details Email *
First Name *
Middle Name
Last Name *
Gender
Date of Birth *
Company Name (if required for invoicing)
Country of Birth *
Town of Birth *
Are you an overseas student studying in Australia on a STUDENT VISA?
If you speak a language other than English at home, please advise what language
How well do you speak English? Very Well Well Not Well Not At All
Are you of Aboriginal origin?
Are you of Torres Strait Islander origin?
Address/Contact Details Building/Property Name
Flat/Unit No.
Street No *
Street Name *
Suburb/Town *
State *
Postcode *
Country *
Phone/Mobile
Alt Phone/Mobile
Work Phone
Postal Address (if different from above) PO Box
Building/Property Name
Flat/Unit No.
Street No
Street Name
Suburb/Town
State
Postcode
Country
Unique Student Identifier (USI) *Please provide your USI number OR one form of identification below (Photocopy required) USI number (if you have one)
Drivers Licence No *
Drivers Licence Card No *
State Issued *
Medicare No
Card colour
Expiry Date
Ref No
Passport No
Country of Issue
Passport Expiry Date
Name as it appears on proof of identity document *
Disability Do you consider yourself to have any disability, impairment or long-term condition? *
Covid-19 Medical Conditions (tick those that apply)
If you have other medical conditions, please provide a brief description of the sort of support which would best suit your individual needs and a Company representative will contact you. If you are not sure if your English language, literacy & numeracy skills are at the standard required to achieve competency, please contact our office and we can provide you with a short Literacy & Numeracy test to complete, which will enable us to ascertain if you will need additional assistance.
Other Medical Conditions
Education What year did you complete High School? *
Highest year completed at High School *
Are you still enrolled in secondary or senior secondary education? No Yes
Have you completed any of the following qualification?
Other Qualifications
Are you applying for RPL or Credit Transfer? *If yes we will contact you to discuss your training
Employment Employer
Employer Address
Job Role
Employment Status Select ... Full Time Part Time Self Employed Unpaid worker-family business Unemployed, seeking full-time work Unemployed, seeking part-time work Not seeking employment
Study Reasons (select one reason which describes your main reason to undertake this course) Study Reasons To get a job To develop my existing business Different Career Extra skills of job To get a better job/promotion Requirement of my job Get into another course Personal interest/self development To get skills for community/voluntary work Other
Would you like additional support with any special needs (literacy, numeracy, physical)?
If yes, please provide a brief description of the sort of support which would best suit your individual needs and the CEO of there representative will contact you.
*
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