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815 Boundary Road Coopers Plains QLD 4108
(07) 2101 2499
4 Hasking Street Caboolture QLD 4510
(07) 2101 2499
Community Rooms, Level 3, City Library Building 155 Herries Street, Toowoomba
(07) 2101 2499
WORK 4 US
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Enrolment
S2-S3 Course
1. Personal Details
Surname:
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Given Names:
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Title: Ms/Mrs/Mr
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Date of Birth:
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(dd/mm/yyyy)
Gender:
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Male
Female
USI Number (click
here
if you do NOT have one)
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Phone No:Home
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Phone No:Work
Mobile
Email:
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Confirm Email Address:
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Residential Address:
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City/Town:
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State:
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Post Code:
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As Above.
Postal Address:
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City/Town:
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State:
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Post Code:
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Are you of Aboriginal origin?
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Please Select
Yes
No
Are you of Torres Strait Islander origin?
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Please Select
Yes
No
Were you born in Australia?
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Please Select
Yes
No
If not, what Country were you born in?
Are you still attending secondary school?
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Please Select
Yes
No
If yes, which school?
What is your highest COMPLETED school level?
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Please Select
Completed Year 12
Completed Year 10
Completed Year 8 & below
Completed Year 11
Completed Year 9
No School or Overseas Schooling
What year did you complete your highest level?
Have you completed any of the following in Australia?
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Please Select
Bachelor Degree or Higher
Certificate IV (or Advanced Certificate/Technician)
Certificate I
Advanced Diploma or Associated Degree
Certificate III (or Trade Certificate)
Diploma or Advanced Diploma
Certificate II
Other
No
If Other : Please detail
2. Credit Transfer
Just Careers Training recognises all AQF Qualifications and Statements of Attainment issued by any other RTO. Do you hold any AQF Qualifications and/or Statements of Attainment that may be useful to shorten the requirements of the qualification you wish to enrol in?
*
Please Select
Yes
No
Details:
Do you speak a language other than English at home?
Please Select
Yes
No
If yes, what language, other than English is spoken at home?
How well do you speak English?
Very Well
Well
Not Well
Not at all
Do you feel that you may require assistance with Language, Literacy and/or Numeracy?
No, Not at all
Some Assistance
Lots of assistance
Do you consider yourself to have a permanent disability, impairment or long term condition?
Please Select
Yes
No
If YES, then please indicate the areas. (You may indicate more than one area)
Please Select
Acquired Brain Injury
Hearing/Deaf
Intellectual
Learning
Mental Illness
Physical
Vision
Medical Condition
Other
Study Reason – which BEST describes the reason for undertaking this training and/or assessment.
Please Select
To get a job
To start my own business
To get a better job or a promotion
To gain extra skills for my job
For personal interest and development (WA only)
For self development (WA only)
To develop my existing business
To try for a different Career
Requirement of my job
To get into another course of study
Other
3. Course and Employment Details
Are you currently employed?
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Please Select
Yes
No
Are you employed Full time or Part time?
Please Select
F/T
P/T
Name of Employer:
Worksite:
Supervisor’s Name:
The code and name of the qualification you are enrolling in:
How would you like to complete this course?
Online
S2 - S3 Full Course - Online Delivery Terms and Conditions
Via Correspondence
S2 - S3 Full Course - Correspondence Delivery Terms and Conditions
Participant Declaration & Privacy Statement
I have read the Participant/Client Information Handbook available online; I understand the roles and responsibilities as the participant, including the pathways and options available to me for training and assessment.
I hereby agree to abide by the RTO policies and procedures relating to fees, charges and regulations of the organisation.
I declare that the information supplied on this form is correct and complete.
I agree that personal information and records (this may include written, verbal, photographic and other formats) collected by the Registered Training Organisation (RTO) may be:
Used by the RTO for research, statistical analysis, program evaluation and internal management purposes.
Used by government departments for audit, research, statistical analysis, program evaluation.
Used for promotional and commercial purposes.
I understand that my personal information will only be disclosed to other third parties with the appropriate legal documents or agreement/ permission in writing by myself.
I have read and understood the terms and conditions set out above.
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