ENROLMENT FORM Do you have a USI (Unique Student Identifier) number? If yes, please provide the 10 digit number If no or don t know tick box 1. Applicant Details Is this the first time you have enrolled at Carey Training? (YIN)... **If No, ie. if you have enrolled before please complete Section 4 ONLY, stating the name of the course and code for which you are now enrolling. If any of your personal details have changed please complete the applicable sections on this form. Title (Please Circle) Mr Ms Mrs Miss Other... Gender ( M / F ) Family Name Given Name. Preferred Name...... Date of Birth (DD/MM/YYYY)..... Address...... Suburb. State. Post Code... Telephone Email...... 2. Job Network / Employment Services Provider / Employer Details Business Name JSID/CITB #:... Address.. Case Manager...Telephone...Email... 3. Emergency Contact Name... Address... Telephone.. Relationship... Revision Issued Dates 30/10/2014 Page 1 of 7
4. Course Enrolment Details Are you enrolling in a full course that will lead to a qualification? (Y/N)... If "Yes", please state Course title & code below: Title:... Code: Carey Training Trainer's Name... If you are enrolling in individual Unit(s) of Competency that do not lead to a full qualification, please nominate them below: Unit Code Unit Title **use extra sheets of paper if required Applicant's Signature:... Date:. PLEASE TICK I have received a copy of the Carey Training Participant Handbook (includes Privacy notice, complaints, Rights and Responsibilities and Policies and Procedures) I understand that my personal details can be divulged for the purpose of audit I have been offered Recognition of Prior Learning I have been fully informed about the qualification to be undertaken. I have received the Manual/workbook for this course. Note: Should students become inactive during a course without contacting Carey Training Pty Ltd their enrolment and/or place may be forfeited & offered to other candidates. YOUR TRAINING AND ASSESSMENT WORKBOOK Do you require your training and assessment workbook to be returned to you electronically following completion of the course? No, I do not require the workbook Yes, I do require the workbook If you require any assistance completing this form, please ask the Enrolling Officer. If you require your workbook returned, please indicate the email address to be used. My e-mail address as specified in Point 1 above E-mail to my JSA as specified in Point 3 above Page 2 of 7
CITY COUNTRY 1. In which city and country were you born? Residential type AUSTRALIAN CITIZEN PERMANENT TAUSTRALIAN RESIDENT NEW ZEALAND CITIZEN LIVING IN SOUTH AUSTRALIA VISA TYPE check (refer next question) Visa type SKILLED REGIONAL SPONSORED (PROVISIONAL) VISA, SUBCLASS 475 AND SUBCLASS 495 SKILLED REGIONAL SPONSORED (PROVISIONAL) VISA, SUBCLASS 487 SKILLED NOMINATED OR STATE TERRITORY SPONSORED, SUBCLASS 489 STATE/TERRITORY SPONSORED BUSINESS OWNER (PROVISIONAL) VISA, SUBCLASS 163 STATE/TERRITORY SPONSORED SENIOR EXECUTIVE (PROVISIONAL) VISA, SUBCLASS 164 STATE/TERRITORY SPONSORED INVESTOR (PROVISIONAL) VISA, SUBCLASS 165 2. Do you speak a language other than English at home? (If more than one language, indicate the one that is spoken most often.) NO, ENGLISH ONLY YES, OTHER PLEASE SPECIFY YES NO 5. Do you consider yourself to have a disability, impairment or long-term condition? If YES, then please indicate the areas of disability, impairment or longterm condition. (You may indicate more than one area.) HEARING/DEAF PHYSICAL INTELLECTUAL LEARNING MENTAL ILLNESS ACQUIRED BRAIN IMPAIRMENT VISION MEDICAL CONDITION OTHER 6. 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 7. In which YEAR did you complete that school level? 3. How well do you speak English? 8. Are you still attending secondary school? VERY WELL WELL NOT WELL NOT AT ALL YES NO 4. Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal AND Torres Strait Islander origin, mark both boxes Yes.) NO YES, ABORIGINAL YES, TORRES STRAIT ISLANDER Page 3 of 7
9. Have you SUCCESSFULLY completed any of the following qualifications? If YES, then tick ANY applicable boxes. BACHELOR DEGREE OR HIGHER DEGREE ADVANCED DIPLOMA OR ASSOCIATE DEGREE DIPLOMA (OR ASSOCIATE DIPLOMA) CERTIFICATE IV (OR ADVANCED CERTIFICATE/TECHNICIAN) CERTIFICATE III (OR TRADE CERTIFICATE) CERTIFICATE II CERTIFICATE I CERTIFICATES OTHER THAN ABOVE NO POST SCHOOL QUALIFICATIONS 10. Of the following categories, which BEST describes your current employment status? (Tick ONE box only.) FULL-TIME EMPLOYEE PART-TIME EMPLOYEE SELF-EMPLOYED NOT EMPLOYING OTHERS EMPLOYER EMPLOYED UNPAID WORKER IN A FAMILY BUSINESS UNEMPLOYED SEEKING FULL-TIME WORK UNEMPLOYED SEEKING PART-TIME WORK NOT EMPLOYED NOT SEEKING EMPLOYMENT 11. Your major reason for study? (Tick ONE box only.) 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 Page 4 of 7
AUTHORITY TO RELEASE TRAINEE INFORMATION Carey Training strictly adheres to the The Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Privacy Amendment Act) in relation to the management of Clients, Students & Trainees information and privacy. The main purpose of this Act is to establish a national standard for the collection, use, storage, correction, disclosure and transfer of personal information. Whilst you are undertaking any Courses and the associated training & assessment at Carey Training, there will be times when training/ assessment personnel may need to discuss details about your training progress and/or results from assessment. This could include your workplace supervisor, colleagues, and employer(s) with whom you have come in contact in relation to your participation in your chosen Course at Carey Training RTO. Be assured that any discussions and/ or release of any information about your training and/or assessment progress will be undertaken solely for the purpose of your development. Your information will not be discussed with other students, or any other persons except by law, and unless we have your written permission to do so. You are required to give permission in writing for the release of your information (whether it be in written form or as part of a discussion) as a part of the enrolment process. Carey Training must also collect your personal information in order to comply with our legal obligations; information collected is only used in relation to the services we provide including for: Audit purposes by the Regulatory Body (ASQA) Recording of Students / Trainees assessment results on the National Reporting Register **Please sign in the spaces provided below. In relation to my participation in any of Carey Training s training courses, I, (Student/Trainee/ Australian Apprentice) give (please print) permission for Carey Training personnel to record and discuss my training and assessment progress and/or results and any related evidences with my employer(s), colleague(s) or supervisor(s) as may be required/ necessary. Signature: Date: Parent/ Name: Guardian s (please print) Signature (for students/trainee s under 18 years of age) Contact No: Page 5 of 7
UNIQUE STUDENT IDENTIFIER (USI) AUTHORISATION To be completed only if you do not already have a Unique Student Identifier (USI) and you want Carey Training to apply for a USI to the Student Identifiers Registrar (Registrar) on your behalf If you do not already have a Unique Student Identifier (USI) and you want Carey Training to apply for a USI to the Student Identifiers Registrar (Registrar) on your behalf, Carey Training will provide to the Registrar the following items of personal information about you: your name, including first or given name(s), middle name(s) and surname or family name as they appear in an identification document; your date of birth, as it appears, if shown, in the chosen document of identity; your city or town of birth; your country of birth; your gender; and your contact details. When Carey Training applies for a USI on your behalf the Registrar will verify your identity. The Registrar will do so through the Document Verification Service (DVS) managed by the Attorney-General's Department which is built into the USI online application process if you have documents such as a Medicare card, birth certificate, driver licence, Australian passport, citizenship document, certificate of registration by descent, ImmiCard or Australian entry visa. If you do not have a document suitable for the DVS and Carey Training are authorised to do so by the Registrar, Carey Training may be able to verify your identity by other means. If you do not have any of the identity documents mentioned above, and Carey Training are not authorised by the Registrar to verify your identity by other means, Carey Training cannot apply for a USI on your behalf and you should contact the Student Identifiers Registrar. In accordance with section 11 of the Student Identifiers Act 2014 Cth (SI Act), Carey Training will securely destroy personal information which Carey Training collect from you solely for the purpose of applying for a USI on your behalf as soon as practicable after the USI application has been made or the information is no longer needed for that purpose, unless Carey Training are required by or under any law to retain it. The personal information about you that Carey Training provide to the Registrar, including your identity information, is protected by the Privacy Act 1988 Cth (Privacy Act). The collection, use and disclosure of your USI are protected by the SI Act. If you ask Carey Training to make an application for a student identifier on your behalf, Carey Training will have to declare that Carey Training has complied with certain terms and conditions to be able to access the online student identifier portal and submit this application, including a declaration that Carey Training has given you the following privacy notice: You are advised and agree that you understand and consent that the personal information you provide to Carey Training in connection with your application for a USI: is collected by the Registrar for the purposes of: o o o applying for, verifying and giving a USI; resolving problems with a USI; and creating authenticated vocational education and training (VET) transcripts; may be disclosed to: Page 6 of 7
o Commonwealth and State/Territory government departments and agencies and statutory bodies performing functions relating to VET for: the purposes of administering and auditing Vocational Education and Training (VET), VET providers and VET programs; education related policy and research purposes; and to assist in determining eligibility for training subsidies; o VET Regulators to enable them to perform their VET regulatory functions; o VET Admission Bodies for the purposes of administering VET and VET programs; o current and former Registered Training Organisations to enable them to deliver VET courses to the individual, meet their reporting obligations under the VET standards and government contracts and assist in determining eligibility for training subsidies; o schools for the purposes of delivering VET courses to the individual and reporting on these courses; o the National Centre for Vocational Education Research for the purpose of creating authenticated VET transcripts, resolving problems with USIs and for the collection, preparation and auditing of national VET statistics; o researchers for education and training related research purposes; o any other person or agency that may be authorised or required by law to access the information; o any entity contractually engaged by the Student Identifiers Registrar to assist in the performance of his or her functions in the administration of the USI system; and will not otherwise be disclosed without your consent unless authorised or required by or under law. Privacy policies and complaints You can find further information on how the Registrar collects, uses and discloses the personal information about you in the Registrar s Privacy Policy accessible at http://www.usi.gov.au/pages/privacy-policy.aspx. The Registrar s Privacy Policy contains information about how you may access and seek correction of the personal information held about you and how you may make a complaint about a breach of privacy by the Registrar in connection with the USI and how such complaints will be dealt with. You may also make a complaint to the Information Commissioner about an interference with privacy pursuant to the Privacy Act, which includes the following: misuse or interference of or unauthorised collection, use, access, modification or disclosure of USIs; and a failure by Us to destroy personal information collected by you only for the purpose of applying for a USI on your behalf. For information about how Carey Training collects, uses and discloses your personal information generally, including how you can make a complaint about a breach of privacy, please refer to Carey Training s Privacy Policy which is provided to you in the Student Handbook. Signature of acceptance by student:... Name of student:.. Date of acceptance:.. Page 7 of 7