Do you have 2 forms of Identification and valid email? *

Yes

Select a course *

Referred by

Referral code (optional)

Please select the method in which you would like to complete your course *

Face to Face with a Trainer

Online

Traineeship

Referred by (Please specify - Manager, One of our Trainers, Self, Other) *

Reason for study *

Method of learning *

Online

Face to face with an Assessor / Trainer

Combination

Title *

First Name *

Last Name *

Preferred Name (Optional) – eg use if you have a nickname you prefer)

Security ID (This section is a password for the purpose of verifying your identity over the phone) *

Are you currently: *

A: Employed or Self Employed - Yes (Please continue completing section 3 Organisation / Workplace details)

Or B: Unemployed/Retired and looking to study - Yes (please write Not Applicable into the relevant areas of Section 3)

Organisation Name *

Manager's Name *

Manager's Phone *

Manager's Email Address *

Organisation Address *

Your Position *

Department *

Area *

Employment Start Date *

Date of birth *

Work Phone (optional)

Mobile *

Work Email *

Alternative E-mail Address (personal/home) *

Website (if applicable)

Street Address *

Street Address 2

Suburb *

State *

Post code *

Country *

Is your residential address the same as your postal address? *

Yes

Street Address

Street Address 2

Suburb

State

Post Code

Country

Gender *

Male

Female

Indeterminate/Intersex/Unspecified

Country of Birth *

City of Birth *

Country of Citizenship *

Are you of Aboriginal or Torres Strait Islander origin? *

Employment Status *

What language do you mainly speak at home? *

Proficiency in Spoken English *

Do you require English Assistance? *

Yes

Are you attending other school/s? *

Yes

If yes, please provide school name

What is the highest level of Secondary schooling you have completed? *

In what year did you complete Secondary School (eg.1965)? *

Do you consider yourself to have a disability, impairment or long-term medical condition which may effect your studies? *

Yes

If you answered yes, please provide more details

Do you have any previous qualifications? *

Yes

If Yes, Please list the qualification names. If No, please write No *

Survey Contact Status *

A - Available for Survey Use

E-Excluded from Survey Use

Please enter your ten (10) character USI *

Full Name *

Phone Number *

Relationship *

Company Name

Time with company

Position

Brief details of duties

Upload Identification document one (1) *

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Upload Identification document two (2) *

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Invoice to be sent to *

Employer / Company

Student

Unknown

Name of person, invoice is to be addressed to *

Invoice to be emailed to *

Coupon Code (if applicable)

Payment amount if known

Payment Type *

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Direct Debit

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I accept the terms & conditions of enrolment into the selected course

Signature *

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