Vertebrate Animal Pest Control Course Enrolment Form Introduction Do you require a Statement of Attainment which is recognised nationally from this Course? Under new Government requirements applying from 1 January 2015, all students studying nationally recognised training in Australia require a Unique Student Identifier (USI). A USI is an account (or reference number) made up of numbers and letters and is issued by the Federal Department of Education and Training. The USI will allow you online access to your training records and results (transcript) through your online USI account. A USI is required for new and continuing students undertaking nationally recognised Vocational Education and Training (VET) courses to receive their statement of attainment or qualification. The USI is available online at www.usi.gov.au at no cost to you. This USI will stay with you for life and be recorded with any nationally recognised VET course that is undertaken from 1 January 2015. You can access your USI account online from computers, tablets or smart phones anytime. If you are a continuing student in a nationally recognised Vocational Education and Training Course, such as the Higher School Certificate or a University Degree, you may already have a USI. You can check at www.usi.gov.au. If you do not have access to the website, we can assist you to check whether you already have a USI and, if you don t, with your permission, assist you to create a USI. If you do not require a nationally recognised Statement of Attainment from this course, you do not require a USI. 1. Do you require a Nationally Recognised Statement of Attainment from this course? N Go to Question 5 2. Do you have a USI? Go to Question 4 N 3. Do you need assistance to obtain or check your USI? A member of staff will contact you. N You are required to provide your USI before the start of the course. 4. What is your USI? Personal details 5. Enter your full name: Family Name (Surname) Given Names: Vertebrate Pest Animal Control Course Enrolment Form Page 1 of 6
6. Sex (Tick ONE box only) Male M Female F 7. Enter your birth date: DD/MM/YYYY 8. In what city were you born 9. What is your Drivers Licence : If you do not have a drivers Licence please provide details of your Passport or Medicare. 10. What is the address of your usual residence? Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state or territory's 'rural property addressing' or 'numbering' system as your residential street address. Building/property name Flat/unit details Street or lot number (e.g. 205 or Lot 118) Street name Suburb, locality or town State/territory Postcode 11. What is your postal address (if different from above)? Building/property name Flat/unit details Street or lot number (e.g. 205 or Lot118) Street name Suburb, locality or town State/territory Postcode Vertebrate Pest Animal Control Course Enrolment Form Page 2 of 6
12. What is your telephone number? Home (0 ) Work (0 ) Mobile (04 ) 13. What is your Firearms Licence : 14. What is your email address? Language and cultural diversity 15. In which country were you born? Australia Other-please specify 1101 16. Do you speak a language other than English at home? (If more than one language, indicate the one that is spoken most often), English only English only go to question 15, other- please specify 1201 17. How well do you speak English? Very well Well t well t at all 1 2 3 4 18. Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal and Torres Strait Islander origin, mark both '' boxes), Aboriginal, Torres Strait Islander Vertebrate Pest Animal Control Course Enrolment Form Page 3 of 6
Disability 19. Do you consider yourself to have a disability, impairment or long-term condition? es 20. If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list: (You may indicate more than one area) Hearing/deaf Physical Intellectual Learning Mental illness Acquired brain impairment Vision Medical condition Other 11 12 13 14 15 16 17 18 19 Schooling 21. What is your highest COMPLETED school level? (Tick ONE box only) Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below Never attended school Never attended school-go to question 21 12 11 10 09 08 02 22. In which YEAR did you complete that school level? 23. Are you still attending secondary school? N Vertebrate Pest Animal Control Course Enrolment Form Page 4 of 6
Previous qualifications achieved 24. Have you SUCCESSFULLY completed any of the following qualifications? N - go to question 23 25. If YES, then tick ANY applicable boxes. Bachelor degree or higher degree Advanced diploma or associate degree Diploma (or associate diploma) 008 410 420 Certificate IV (or advanced certificate/technician) 511 Certificate Ill {or trade certificate) Certificate II Certificate I Certificates other than the above 514 521 524 990 Employment 26. Of the following categories, which BEST describes your current employment status? (Tick ONE box only) Full-time employee 01 Part-time employee 02 Self-employed - not employing others 03 Employer 04 Employed - unpaid worker in a family business 05 Unemployed -seeking full-time work 06 Unemployed -seeking part-time work 07 t employed -not seeking employment 08 Vertebrate Pest Animal Control Course Enrolment Form Page 5 of 6
Study reason 27. Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? (Tick ONE box only) To get a job 01 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 02 03 04 05 06 07 08 12 11 Registration Your acceptance and registration is dependent on the fee being paid prior to the start of the course. You will receive a confirmatory email message before the course start date. If you have not provided an email address, please call our office before the course start date to confirm your attendance. Signature of Trainee: Date:. Vertebrate Pest Animal Control Course Enrolment Form Page 6 of 6