White Card Online Enrolment Form 1. Personal Details Gender * Male Female USI Number (click here if you do NOT have one) * As Above. Emergency Contact Details * Are you of Aboriginal or Torres Strait Islander Origin? * Please Select Yes No Were you born in Australia? * Please Select Yes No Are you still attending secondary school? * Please Select Yes No What is your highest COMPLETED school level? * Please Select Completed Year 12 Completed Year 10 Completed Year 8 & below Completed Year 11 Completed Year 9 No School or Overseas Schooling Have you completed any of the following in Australia? * 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 Are you registered or tending to be registered to be registered in an apprenticeship or traineeship for this qualification in NSW? * Please Select Yes No Not Sure 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 Do you speak a language other than English at home? Please Select Yes No 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? * Please Select Yes No Are you employed Full time or Part time? Please Select F/T P/T 4. SafeWork Declaration Prior to enrolment in HRW Training (or before coordinating a separate HRWL Assessment), the student enrolling must declare if they - * My residential address is in NSW is in other parts of Australia other Have had a HRW Licence suspended or cancelled anywhere in Australia with in the last five years Yes No Have previously been convicted or entered into an enforceable undertaking under the WHS law in Australia? Yes No Are you hearing impalred and do you require a registered Auslan interpreter for a HRWL Assessment Yes No Do you hold a HRW Assessor accreditation? Yes No 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. Just to further protect your information by making sure you are not a robot, please complete the following before sending Security Code: *
Just to further protect your information by making sure you are not a robot, please complete the following before sending
