ATS Student Enrolment Form

Transcription

1 Student USI number Applicant Type Job Seeker Fee for Service (FFS) Employed Worker/Traineeship Single unit of competency Job Seeker to complete Are you currently in social housing or on the Housing Register? Yes No How long have you been unemployed for? COMMENCEMENT DATE: / / DURATION OF TRAINING CONTRACT: Qualification/Unit Code and Title 1. A Personal Details Family Name Male Female Given Names DOB / / Home Phone Home ( ) Mobile Emergency Contact Name Emergency Contact Number Emergency Contact Relationship Usual Residence Number Street Suburb State State Postcode Postal address Same as above Other Citizenship/Residency Status Were you born in Australia? Yes No Place of Birth? If you were born outside of Australia Country of Birth? Place of Birth? Australian Citizen Australian Resident Permanent Residency Visa New Zealand Passport Other (i.e. East Timorese Asylum seeker Special Category or Temporary Protection) Do you speak another language other than English at home? No, English only Yes, other - please specify How well do you speak English? Very wellwellnot wellnot at all Version: 3.9 Date: 21/02/2017 Authorised By: Jann Burrows Page 1 of 5

2 Do you identify as Aboriginal or Torres Strait Islander? Neither Aboriginal nor Torres Strait Islander Aboriginal Aboriginal and Torres Strait Islander Torres Strait Islander Do you consider yourself to have a disability, impairment or long-term condition? Yes No Hearing/Deaf Vision Physical Intellectual Learning Mental Illness Acquired Brain Impairment Medical Condition Other Additional Training Support may be required because of any disability you might have, or because English is your second language. Please inform your trainer if you think that you might require additional support at any point in the course. Education What stage did you complete school? What year did you complete? Year 12 Year 11 Year 10 Year 9 Year 8 Year 7 Have you previously COMPLETED any of the following qualification levels? Yes No Bachelor degree or higher Advanced diploma (associate degree) Diploma Certificate IV Certificate III Certificate II Certificate I Other Certificate Qualification Code: Date Completed: / / Qualification Title: Employment Full-time employee Part-time employee Self-employed Casual/Temp Unemployed - Seeking full-time work Unemployed - Seeking part-time work Not Employed - Not seeking employment Employer TO BE COMPLETED IF YOU ARE A JOB SEEKER JSID/ CRN Number: JSA Name Street Suburb State State Postcode P/C Version: 3.9 Date: 21/02/2017 Authorised By: Jann Burrows Page 2 of 5

3 TO BE COMPLETED IF YOU ARE CURRENTLY EMPLOYED Start date of employment: / / Legal name of employer: ABN: Name of workplace: Workplace address: Phone number: Contact person: How did you find out about the course? Job Network Centre Employer Word of Mouth Other Why are you doing this course? To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion It was a requirement of my job I wanted extra skills for my job To get into another course of study For personal interest or self-development Other reasons Will you be applying for Recognition of Prior Learning (RPL)? Yes No RPL is available to those who have a minimum of 12 months experience in the industry, based on your experience, knowledge and supporting evidence you will be asked to provide, this could potentially reduce the number of assessments in this qualification. Note: This will be subject to the trainer s assessment of your underpinning knowledge and experience. Will you be applying for Credit Transfer? Yes No Credit can apply if you have completed national accredited units of competencies from another accredited qualification and can provide ATS a copy of your Certificate or Statement of Attainment potentially reducing the number of assessments in this qualification. Note: This will be subject to the currency of the qualification Training Approach What mode of delivery are you undertaking to complete this training course? Online Employment Based Correspondence Classroom Based Blended Version: 3.9 Date: 21/02/2017 Authorised By: Jann Burrows Page 3 of 5

4 Applicant Identification IMPORTANT: The ATS Enrolling Officer must where possible take a copy of the applicant s identification for the RTO s records and/or at a minimum sight and document the card/certificate number produced by the applicant in the space provided below. Photo ID must also be shown for verification of identity purposes and proof of age. Please present 2 types of evidence to support your status. I have provided the following evidence of my identity to be attached to this form (please tick 2 including 1 with photo ID): Passport Current Driver s Licence (Double sided Colour copy QLD only) Birth Certificate Green Medicare Card (Colour copy QLD only) Proof of Age Card Naturalisation Certificate Permanent Residency Visa Other Card/Certificate Number LANGUAGE LITERACY AND NUMERACY QUESTIONS 1 Circle the correct word (in brackets). a) Shirley and Andrew had (their/there) car stolen on Monday night. b) Ruth (bought / brought) a loaf of bread from the supermarket for $ 3.50 c) Tran (payed/paid) $99.00 for a new DVD player. d) In the (passed / past) year there has been an increase in the population. 2 In your own words, write a short paragraph about your favorite holiday destination and why you like it. (This does not have to be somewhere you have already visited in the past it can be where you would like to go in the future) 3 The following questions can be answered with or without a calculator (Upon request your ATS Representative completing the enrolment with you today will provide you with a calculator) a) $ $2.45 = b) 613 X 10 = c) X 3 = d) = e) Bill caught the 10.25am Train. He arrived at work at 11.10am how long did the trip take? 35 Minutes 1 Hour 5 Minutes 45 Minutes 15 Minutes Version: 3.9 Date: 21/02/2017 Authorised By: Jann Burrows Page 4 of 5

5 Privacy Statement and Student Declaration (please tick) I understand and consent if I do not already have a Unique Student Identifier (USI) ATS will apply for a USI on the behalf of the student via the Identifiers Registrar. I have provided my personal information and the information I have provided to ATS during my enrolment is collected for the purpose of registration, training delivery and assessment, preparing statistics, reporting, program monitoring and evaluation and may be disclosed to and used for these purposes by the Commonwealth Department of Education, Training and Youth Affairs (and its contractors), Centrelink, and other commonwealth agencies such as the Department of Employment and Workplace Relations and Small Business, the Department of Treasury, the Department of Immigration and Multicultural Affairs, State/Territory Government Departments or agencies (and their contractors), employers and nominated Australian Apprenticeship Centre s, and may be otherwise disclosed without consent where authorised by law. I agree to abide by ATS terms and conditions as outlined in the Student Handbook Prior to enrolment I have been informed of the fees, services and refund policy Further, I will; Work towards achieving the qualification identified in the most appropriate timeframe; Undertake any training and assessment required in accordance with the Training Plan; Allow photographic evidence of my activities in support of training and assessment to be taken and to be used by ATS for general publicity purposes; I acknowledge and agree to the terms described in the above Privacy Statement & Student Declaration I understand that if under the age of 18 years, I must provide a signed consent by my parent/guardian. I declare to the best of my knowledge the accuracy of the information provided in this enrolment are true and correct. Applicant Signature: Date: / / Parent /Guardian Signature: Date: / / (If under 18yrs) OFFICE USE ONLY Enrolling officer s Declaration I confirm that the applicant has been informed of ATS policies and processes and has been provided a copy of the Student Handbook, and that the applicant is aware of the consequences arising from false, misleading or an incomplete declaration. I have also sighted the applicant s identification and where possible taken copies to be attached to this enrolment form. LLN Support required: Yes No Specify: Enrolling Officer s Signature: Date: / / Version: 3.9 Date: 21/02/2017 Authorised By: Jann Burrows Page 5 of 5