91397 Barrington Training Services Pty Ltd Please complete all sections of this form and return to Barrington Training Services. FOOD SAFETY SUPERVISORS COURSE Options: Please Tick Course: Cost per Participant - GST inclusive 1: Face to Face Food Safety Supervisor Course No Prior training $250.00 2: Online: Food Safety Supervisor Course $189.00 Course Units: SITXFSA001 Use hygienic practices for food safety SITXFSA002 Participate in safe food handling practices Surname PARTICIPANT DETAILS- please complete your personal details below Given Name Title Address Suburb State Phone Mobile Post Code Gender M / F Email Date of Birth D D / M M / Y Y Town/City of Birth Country of Birth Unique Student Identifier USI # Click on the following link to create your USI: http://www.usi.gov.au/create-your-usi/ Note: Barringtons can be prevented from issuing you with a nationally recognised qualification or Statement of Attainment if you do not have a USI. IDENTIFICATION Positive identification must be obtained and should contain a photo issued by a government or commercial organisation for the purpose of proof of identity or age. Documentary evidence will be recorded and retained by Barrington Training Services for the purpose of auditing processes as well as legislative reporting requirements. Please attach or email a copy of your ID. ID TYPE ID/Documentation Number Drivers Licence Passport Birth Certificate Other Date reviewed: June 2018 Version:2 Page 1 of 9 Enrolment Form Food Safety Supervisor 2018
ELIGIBILITY: To access government funding we need you to answer the following question to assess your elgibility NATIONALITY/LANGUAGE Are you of Aboriginal origin? Are you Torres Strait Islander origin? Are you Aboriginal AND Torres Strait Islander origin? Please provide documentary evidence Do you speak another language other than English at home? If YES, please specify the language spoken Will you need help with English? CITIZENSHIP (Tick the box that applies to you) I am an Australian Citizen I am a New Zealand Citizen I am an Australian Permanent Resident None of the above applies ( Please specify ) DISABILITY Do you consider yourself to have a permanent and significant disability If YES, specify disability Do you require special assistance because of your disability Please provide documentary evidence Are you a dependent of a Disability Support Pensioner? EDUCATION Do you require additional language, literacy and numeracy support? What is your highest completed school level? 7 8 9 10 11 12 In which year did you complete that level? Are you currently undertaking any other study? PRIOR EDUCATION Since leaving school, have you completed any qualification If yes, tick any of the following boxes that apply to you, please add the name of the qualification ticked Trade certificate Advanced/Technician Certificate Certificate other than above Associate Diploma Undergraduate Diploma Degree or Postgraduate Diploma What was your certificate level? (II, III or IV) What year was the last qualification completed Would you like to apply for RPL or Credit Transfer? If Yes please provide evidence to your trainer through BTS s RPL process. Please refer to our student information handbook on our website. Date reviewed: June 2018 Version:2 Page 2 of 9 Enrolment Form Food Safety Supervisor 2018
EMPLOYMENT DETAILS 1. Are you employed full-time / part-time? FULL TIME If unemployed, go to question 8. 2. What date did you commence employment with this employer? 3. Employer Name : Employer Address: PART TIME 4. Suburb State Postcode 5. Contact Person 6. Phone 7. Email Address 8. Are you unemployed? If Yes how many weeks? No of Weeks Are you a Comonwealth Welfare recipient/the dependent of a Commonwealth Welfare recipient? If yes to the above question what type of welfare do you receive? Who is your Service Provider and what is their Service Provider Organisation ID? What is your Client ID or JSID number? HOUSING DETAILS- Do you live in NSW Social Housing such as public housing, community housing, aboriginal housing, crisis accommodation or are provided rental assistance by Housing NSW? If YES please provide documentary evidence. Date reviewed: June 2018 Version:2 Page 3 of 9 Enrolment Form Food Safety Supervisor 2018
DECLARATION OF UNDERSTANDING-please refer to our information handbooks Please read Schedule 1 and Schedule 2 carefully. If you do not understand what you are being asked, please contact Barrington Training Services. Schedule 1: I understand that the training course has an assessment component. These assessments are part of the training course and I must complete them. I will not have completed my training program until Barrington Training Services (BTS) has received my completed assessments. I agree to hand in all assessments by the date agreed with my Trainer/Assessor. The BTS Trainer/Assessor will decide the assessment outcome. The BTS Trainer/Assessor will discuss the assessment outcomes with me. If I need to do further work to be credited with a completed unit or course of study, I agree to complete the work in the time agreed with my Assessor. If I do not agree with an assessment decision, I may use the Assessment Appeals Policy to have the assessment decision reconsidered. If I appeal an assessment decision, I agree to stand by the assessment decision as a final assessment of my competence in the unit or course of study. I also understand training places are limited in some courses and I may not be able to participate in the class at the time I have nominated. I authorise BTS to apply for a USI on my behalf and have read the privacy information at http://www.usi.gov.au/training- Organisations/Documents/privacy-Notice.pdf and consent to the collection, use and disclosure of my personal information. I authorise BTS to access my Unique Student Identifier (USI) Information. I authorise BTS to use the Student Provider Calculator on my behalf to calculate my student fee. I grant permission for Barringtons to use group photos or videos of me participating in training and or attending a graduation. Schedule 2: CONSENT TO USE AND DISCLOSURE OF PERSONAL INFORMATION I (First, middle and last name) of (current residential address) with date of birth understand and agree that, under the Data Provision Requirements 2012, Barrington Training Services (RTO ID# 91397) is required to collect personal information (information or an opinion about me), collected from me, my parent or guardian, such as my name, Unique Student Identifier, date of birth, contact details, training outcomes and performance, sensitive personal information (including my ethnicity or health information) and other enrolment and training activity-related information (together Personal Information) and disclose that Personal Information to the National Centre for Vocational Education Research Ltd (NCVER). My Personal Information (including the personal information contained on my enrolment form and my training activity data) may be used or disclosed by Barrington Training Services (RTO ID# 91397) for statistical, regulatory and research purposes. Barrington Training Services (RTO ID# 91397) may disclose my personal information for these purposes to third parties, Date reviewed: June 2018 Version:2 Page 4 of 9 Enrolment Form Food Safety Supervisor 2018
including: School if I am a secondary student undertaking VET, including a school-based apprenticeship or traineeship; Employer if I am enrolled in training paid by my employer; Commonwealth and State or Territory government departments and authorised agencies, including the NSW Department of Industry (Department); NCVER; Organisations conducting student surveys; and Researchers. Personal Information disclosed to NCVER may be used or disclosed for the following purposes: issuing a VET Statement of Attainment or VET Qualification, and populating Authenticated VET Transcripts; facilitating statistics and research relating to education, including surveys; understanding how the VET market operates, for policy, workforce planning and consumer information; and administering VET, including program administration, regulation, monitoring and evaluation. I may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. I may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose my Personal Information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER s website at www.ncver.edu.au). The Department may disclose my Personal Information to other Australian government agencies, including those located in States and Territories outside New South Wales. The above government agencies may use my Personal Information for any purpose relating to the exercise of their government functions, including but not limited to the evaluation and assessment of my training, the determination of my eligibility to receive subsidised training or for any Fee Exemptions or Concessions. My Personal Information may also be disclosed to other third parties if required by law. I also acknowledge and agree that the Department may contact me by telephone email or post during or after I have ceased subsidised training with Barrington Training Services (RTO ID# 91397) for the purposes of evaluating and assessing my subsidised training. I declare that the information I have provided to the best of my knowledge is true and correct. I consent to the collection, use and disclosure of my Personal Information in the manner outlined above. PRINT FULL NAME: SIGNATURE: DATE: / / Note: If under 18 years of age at the time of giving consent, then the consent of their guardian is required PRINT FULL NAME OF GUARDIAN: SIGNATURE: DATE: / / Date reviewed: June 2018 Version:2 Page 5 of 9 Enrolment Form Food Safety Supervisor 2018
PAYMENT DETAILS PARTICIPANT TO COMPLETE Payment can be made by the following methods. Please tick which method you will use. Credit Card: Cheque: EFT: Please complete the appropriate section: CREDIT CARD: Visa Mastercard Bankcard Card Name: Card Number: / / / Expiry: / Sequence Number: (This is the 3 digit number located on the back of the card) Amount: CHEQUE: All cheques are to be made payable to Barrington Training Services. Please allow 7 working days for personal cheques to clear. Please mail to: Barrington Training Services PO Box 1223 Castle Hill NSW 1765 Attn: Kay Moultrie EFT: You can direct deposit into our bank account. If you use this method please place your full name in reference field when completing the transfer. Bank: Commonwealth Bank BSB No: 062-347 Acct No: 10371211 Acct Name: Barrington Group Australia Reference: Your Full Name (bank will include in deposit advice so we can identify your deposit) Date that you completed the transfer: / / Date reviewed: June 2018 Version:2 Page 6 of 9 Enrolment Form Food Safety Supervisor 2018
LANGUAGE LITERACY NUMERACY ASSESSMENT TASKS Part A :Plan time Complete the following task Sonya works at a hotel as an Administration Assistant. She enjoys her job a lot as she has the opportunity to work in different departments of the hotel. Use the information on Sonya s timetable to answer Questions 1-6. Monday Tuesday Wednesday Thursday Friday 8.00am 9.00am 10.00am 11.00am 12.00pm 1.00pm 2.00pm 3.00pm 4.00pm 5.00pm Work in Reception in the foyer Work in Health and Fitness Centre Staff meeting Work in Reservations Work in the Retail Liquor store Lunch with Nicky Work in the Retail Liquor store Work in the Marketing Department Software Training in Room 117 Work in the Marketing Department 6.00pm 1. What time does Sonya need to be at the Health and Fitness Centre on Tuesday? 2. Where will Sonya work on Monday? 3. What day will Sonya work in the Retail Liquor store? 4. What time is lunch on Thursday? 5. What is Sonya doing on Friday afternoon from 1-4pm? 6. When is the staff meeting? How long will the meeting last? Date reviewed: June 2018 Version:2 Page 7 of 9 Enrolment Form Food Safety Supervisor 2018
Part B : Plan time Complete the following task Joseph works in a club as a Bar Attendant. He has a busy week ahead. 1. Read Joseph s Job Tasks listed below. 2. Mark the time and write the information about each of the Job Tasks in the timetable below. 8.00am Monday Tuesday Wednesday Thursday Friday 9.00am 10.00am 11.00am 12.00pm 1.00pm 2.00pm 3.00pm 4.00pm 5.00pm 6.00pm Joseph s Job Tasks for the week ahead 1. Joseph will spend Monday in the Bar Area working with his supervisor to clean and restock the bar from 9.00am to 5.00pm. 2. On Tuesday he will work in the cellar with the Cellar Manager starting at 10.00am and finishing at 5.00pm. 3. On Wednesday there is a 1 hour team meeting beginning at 9.00am. 4. A Wine company is coming to give a 1 hour presentation about new varieties of wine on Wednesday at 12.00pm. The supervisor has asked that the whole team attend. 5. On Thursday he will attend a 6 hour training seminar at Barringtons Training from 8am. 6. On Friday he has a 1 hour dental appointment at 10 o clock. Date Reviewed: June 2018 Version : 2 Page 8 of 9 Enrolment Form Cert II
Part C: About Me Complete the following task 1. Write a paragraph about what study or work you have done since leaving school. 2. Give three reasons why you have enrolled in this course and what you plan to do when you finish the course. ASSESSOR COMMENTS/FEEDBACK: Competent Assessors Name: Assessors Signature: Date Not yet competent Participant Name: Participant Signature: Date LNN Assessment sourced from ACSF Assessment Tasks User Guide Commonwealth of Australia. Contextualised to meet ther needs of Barrington Training Services. Date Reviewed: June 2018 Version : 2 Page 9 of 9 Enrolment Form Cert II