APPLICATION FORM LICENSED OCCUPATIONS

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LICENSED OCCUPATIONS SECTION A Applicant Document Checklist INSTRUCTIONS FOR APPLICANTS: Please review the application and document guidelines located on the website Information for Applicants You may not be able to submit all examples of evidence as listed however you must be able to demonstrate your skills and knowledge to meet the Australian standard. For further information on the Australian qualification and standards go to www.training.gov.au Onshore Pathway 1 Air Conditioning & Refrigeration Mechanic applicants will be required to complete a Practical Assessment in South Australia or Tasmania. Please select ONE licensed occupation OCCUPATION / ANZSCO CODE 334111 Plumber (General) CPC32413 Certificate III in Plumbing 341111 Electrician (General) UEE30811 Certificate III in Electrotechnology Electrician 341112 Electrician (Special Class) Minimum Benchmark: UEE30811 Certificate III in. Electrotechnology 342111 Air Conditioning & Refrigeration Mechanic UEE32211 Certificate III in Air Conditioning and Refrigeration Please select ONE pathway PATHWAY Pathway 1 for those who do not hold an Australian qualification Pathway 2 for those who do hold a relevant Australian qualification (Qualified Applicants) or a Current, Identified Australian Occupational Licence (Licensed Applicants) Please select ONE program Permanent Migration (GSM/ENS/RSMS) PROGRAM Temporary Skill Shortage (TSS) Visa not available for Plumber (General) or Air Conditioning & Refrigeration Mechanic CRICOS Provider No. 00124K (Melbourne) 02475D (Sydney) R Code: 3113

Please tick what you have submitted in support of your application. Refer to Section K for instructions on how to submit evidence correctly. GUIDELINES REGARDING ELECTRONIC DOCUMENT SUBMISSION: You may submit documents electronically: scans must be of original documents; scans of copies will not be accepted scans must be in colour; black and white copies will not be accepted the minimum scan resolution is 150 dpi (dots per inch). Electronic documents do not need to be certified. You will be requested to present original documents for verification prior to Technical Assessment. / x Application Completed VU Application Form [MANDARY] / x Identity Evidence Two recent photographs colour, passport sized, certified as true image, signed and dated [MANDARY -Section J] Passport bio page colour, must show name, photo and date of birth [MANDARY] Birth Certificate Evidence of name change/s - if applicable / x Evidence of Skills and Experience CV/Resume [MANDARY] - must have a detailed summary of employment history with a list of tasks performed. First Aid Certificate - including CPR & accredited course completed [MANDARY for Plumber] Certificates of Qualification/s [evidence of Australian qualification MANDARY for Pathway 2 Qualified Applicants] Certificates should be accompanied by an Academic Transcript of Results for the units completed. Academic Transcript / Statement of Results - for completed qualifications [MANDARY for Pathway 2 Qualified Applicants] Statement of Attainment for accredited short course or partially completed qualification Licenses and Industry Memberships - including card licences MANDARY for Pathway 2 Licensed Applicants - Current, Identified Australian Occupational Licences must be unrestricted. If you have more than one license please provide licenses for all streams and/or all states in which you have worked. Employer Statements [MANDARY] Minimum of two (2) statements if with current employer less than two years. Minimum of one (1) statement if with current employer at least two years or more. Please refer to Section E for specific requirements for Employer Statements. Must include email addresses and contact phone numbers.**see below for specific Pathway 2 criteria. References additional, trade related If you are self-employed, you may get references from people for whom you have undertaken work. They will need to be specific about the job that was performed, and preferably be accompanied by photographic evidence of the work. Position Descriptions / Job Tasks / Performance Review Reports Tax Records Annual Payment Summaries / Group Certificates [MANDARY for Pathway 2] Statement from your registered / certified accountant [MANDARY for self-employed applicants] PATHWAY 2 ELIGIBILITY CRITERIA: You must be able to demonstrate at least three (3) years full time paid employment in the relevant and directly related trade, including 12 months full time paid employment in the nominated trade in the THREE (3) years prior to lodging your application. For applicants applying with a Current, Identified Australian Occupational Licence this 12 months employment must be in Australia. Evidence of employment undertaken on a part time basis can also be considered and counted toward the employment requirement on a pro rata basis. www.vu.edu.au/skilled-migration 1 July 2018 2

SECTION B - Applicant Details INSTRUCTIONS FOR APPLICANTS: Please read the document Information for Applicants before you complete this form You must complete this form in English and answer ALL the questions Please accurately type into the spaces provided OR if hand writing, clearly print your responses Title Mr Mrs Ms Miss Other: Surname First Name Second Name Preferred name order on official VU documentation Home Address Street Name, Town/City County/Province Postcode, Country Postal Address (if different from above) Home Phone No. International country and area code prefix. e.g. + 44 1752 8991234 Alternative Contact No. Mobile No. Email Date of Birth Street Name Town/City Postcode Street Name Town/City Postcode County/Province Country County/Province Country Age Gender Male Female Unspecified Current Passport No. National Insurance number (UK only) Current Visa Status including Expiry Date (attach VEVO if applicable) Country of Citizenship (Passport holder & must also reflect Nominated Country) Country of Residence Country of Training www.vu.edu.au/skilled-migration 1 July 2018 3

SECTION C Agent Authorisation (if applicable) INSTRUCTIONS FOR APPLICANTS: An Agent may include; migration agent, recruitment agent, employer/sponsor or any representative or person acting on behalf of the applicant, e.g. family member etc. The skilled migration outcome letter and qualification will be sent directly to the applicant s nominated address unless otherwise stipulated. If you wish to appoint more than one agent or representative please complete an additional Agent Authorisation Form located at www.vu.edu.au/skilled-migration. Do you authorise an agent or representative to act for you in regards to your application? No go to Section D. Yes please provide details below. Name of Applicant Name of Agent or Representative (Additional names of Agent) Agent s Company Name Street Name Agent s Address Postal Address (if different from above) Agent s Phone No. International country and area code prefix. Agent s Mobile No. Email Town/City Postcode Street Name Town/City Postcode County/Province Country County/Province Country Fax No. Do you want all your correspondence including the migration outcome letter and qualification to be sent to this agent s address? OR Do you want the migration outcome letter and qualification sent to your personal address as listed on this application? Yes No Yes No Applicant s Signature Date Agent s Signature Date www.vu.edu.au/skilled-migration 1 July 2018 4

SECTION D - Qualifications Please provide details of your FORMAL training Name of Qualification Awarding Institute City/Country Period MONTH YEAR Please attach scanned copies of any qualifications and academic transcripts listed above. Please provide details of your INFORMAL and/or on-the-job training Name of Training Program Name of Employer or Awarding Institute City/Country Period MONTH YEAR Please attach scanned copies of any qualifications and academic transcripts listed above. Please provide details of your relevant Licenses and/or Industry Memberships Name of License/Membership Issuing Authority Issue Date Expiry Date Please attach scanned copies of any qualifications and academic transcripts listed above. www.vu.edu.au/skilled-migration 1 July 2018 5

SECTION E Employment History Please provide details of your employment history Name of Employer Occupation/Position Brief description of duties Start Date End Date Please attach an Employer Statement to support all the positions you have held. Please follow the instructions below. EMPLOYER STATEMENTS [MANDARY] Every employment statement you provide to Victoria University must include: the date the letter was issued the name of the business the nature of the business (e.g. construction company, hotel) a detailed half-page description/overview of business and the services/products provided by the business the address of business where you worked when you worked there, i.e. start date and end date of your employment the nature of your employment (full-time, part-time, casual) your normal hours of work per week your job title (occupation) a detailed description of the nature and content of the work you undertook a detailed description of the machines, tools and/or equipment you used the signature, name, position, telephone and email contact details of the person authorised to make the statement the length of time that the person signing the statement has been supervising you must also be clearly indicated all employment statements must be on letterhead used by the employer s business where possible. If you are unable to provide employment statements on letterhead you must provide us with an explanation of why this is not possible. We may contact an employer to verify information provided in an employer statement. A contact telephone number and email address is required for every person who supplies an employment statement. A mobile telephone number will not be sufficient as a primary contact number unless we can independently verify that the mobile telephone number is linked to the organisation. If you send original employment statements they will not be returned. www.vu.edu.au/skilled-migration 1 July 2018 6

SECTION F Referees Please list your Referees (e.g. a Referee may be a former employer, etc.) Name Relationship to Applicant Address Phone / Mobile No. Email Address SECTION G Attachments Please provide a brief description of the attachments you have submitted with your application: Document Description (e.g. Resume, Photos, Statement of Attainment, Certificate, etc.) Office Use Only Assessor to use this section to align documents to specific units of competency and identify key questions for competency conversation. www.vu.edu.au/skilled-migration 1 July 2018 7

SECTION H Payment Form Applicant s Full Name Email Contact Phone No. International country and area code Mobile No. Date Payment Required for (payment will only be deducted upon progression to next stage and is non-refundable after the assessment has occurred) Pathway 1 *$870 Payment 1: Documentary Evidence Assessment PLUS ± $330 (GST inclusive) Govt Administration Fee (from 1 Oct 2017) # $1,830 Payment 2: Technical Interview with Practical Skills Demonstration Pathway 2 *$680 Payment 1: Documentary Evidence Assessment ± $330 (GST inclusive) Govt Administration Fee (from 1 Oct 2017) $880 Payment 2: Technical Interview # Pathway 1 $3,030 (Technical Interview with Practical Skills Demonstration) TAL AMOUNT PAYABLE Pathway 2 $1,890 (Technical Interview for applicants with AQF qualification and/or full Australian License) Please complete the following CREDIT CARD authorisation: I, authorise Victoria University to debit my credit card for the total amount of Pathway 1 OR Pathway 2 (circle payment option above) as payment for the processing of this application and understand that the fee is nonrefundable once an assessment has occurred. Credit Card Type MasterCard VISA Credit Card No - - - Expiry Date M M Y Y CVV No. Name on Card Signature of Cardholder www.vu.edu.au/skilled-migration 1 July 2018 8

PAYMENT INFORMATION FOR APPLICANTS * Payment 1 includes a non-refundable $100 Administration fee collected upon receipt of the application. Fees will be deducted in Australian dollars in the form of Credit Card ONLY Payments will only be deducted upon progression to the next assessment stage Payments are non-refundable once the assessment stage has occurred ± The Government Administration Fee applies to all TRA approved R trade skill assessments from 1 October 2017. It will be charged once the file is registered as Decision Ready, not upon receipt of application. NCVER Privacy Notice Under the Data Provision Requirements 2012, Victoria University is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by Victoria University for statistical, regulatory and research purposes. Victoria University may disclose your personal information for these purposes to third parties, including: School if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship; Employer if you are enrolled in training paid by your employer; Commonwealth and State or Territory government departments and authorised agencies; 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. You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. You may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your 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). Student Declaration and Consent 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 accordance with the Privacy Notice above. STUDENT SIGNATURE [or electronic acknowledgement] DATE www.vu.edu.au/skilled-migration 1 July 2018 9

Victorian Government VET Student Enrolment Privacy Notice The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds vocational education and training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic). Collection of your data Victoria University is required to provide the Department with student and training activity data. This includes personal information collected in the enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth s Unique Student Identifier (USI). Victoria University provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at http://www.education.vic.gov.au/training/providers/rto/pages/datacollection.aspx. Use of your data The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning. A student s USI may be used for specific VET purposes including the verification of student data provided by Victoria University; the administration and audit of VET providers and programs; education-related policy and research purposes; and to assist in determining eligibility for training subsidies. Disclosure of your data As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors, other government agencies, professional bodies and/or other organisations for VET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER). Legal and Regulatory The Department s collection and handling of enrolment data and VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also authorised to collect and handle USIs in accordance with the Student Identifiers Act 2014 (Cth) and the Student Identifiers Regulation 2014 (Cth). Survey participation You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria. Please note you may opt out of the NCVER survey at the time of being contacted. Consequences of not providing your information Failure to provide your personal information may mean that it is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy Access, correction and complaints You have the right to seek access to or correction of your own personal information. You may also complain if you believe your privacy has been breached. For further information, please contact Victoria University s Privacy Officer in the first instance by phone +61 3 9919 1164 or email privacy.officer@vu.edu.au Further information For further information about the way the Department collects and handles personal information, including access, correction and complaints, go to http://www.education.vic.gov.au/pages/privacypolicy.aspx. For further information about Unique Student Identifiers, including access, correction and complaints, go to http://www.usi.gov.au/students/pages/student-privacy.aspx. I acknowledge that I have read the Victorian Government s VET Student Enrolment Privacy Notice. [STUDENT SIGNATURE] [DATE] www.vu.edu.au/skilled-migration 1 July 2018 10

SECTION I Statistical Enrolment Data (Pathway 1 only DO NOT complete if you are applying as a Pathway 2) After you have completed your successful skills assessment, accredited gap training and 12 months recorded/supervised employment, Victoria University or its Consortium partner R will enrol you into the relevant qualification in order to issue the associated Australian Qualification. This section does not have to be completed if you intend to do your gap training at another institute. The regulator in the state or territory in which you are planning to reside, will outline the necessary training required to obtain your qualification and the Australian R that can deliver gap training. Do you consider yourself to have a disability, impairment or long-term medical condition? (please tick) No Yes Please complete below: I would like information about available services. Acquired Brain Impairment Hearing/Deaf Intellectual Learning Medical Mental Illness Mobility Physical Vision Other Do you speak a language other than English at home? No Yes, Language: How well do you speak English? Very well Well Not Well Not at all In what country were you born? Year of arrival in Australia Are you of Aboriginal or Torres Strait Islander origin? Yes No, I am neither Aboriginal nor Torres Strait Islander If you have Permanent Residence status, which statement best describes your circumstances? Permanent Residence does not apply to me I am residing outside Australia for the semester I am residing in Australia during the semester I have had permanent residence for more than 12 months In which year did you leave Secondary School? In which year did you complete highest secondary level? Where was your permanent home address during year 12? Postcode: Suburb/Town: What was the highest secondary school level completed? Did not go to school Year 7 or below Year 8 or below Year 9 or below Completed Year 10 Completed Year 11 Completed Year 12 Have you done any training with a VET registered R or an ACE provider since 2011? Yes - list up to 3 training organisations below 1 2 3 No www.vu.edu.au/skilled-migration 1 July 2018 11

Which of the following qualifications have you successfully completed? Enter one or more of the following codes in the columns below: A = Australian E = Australian Equivalent I = International A E I Bachelor Degree or Higher Degree Level Advanced Diploma or Associate Degree Level Diploma Level Certificate I Certificate II Certificate III Certificate IV Miscellaneous Education What was the highest level of education completed by your parents/guardians? Father Mother Postgraduate Qualifications (e.g. Masters, PhD) Bachelor Level Qualifications Other Post School Qualifications (e.g. VET/TAFE Certificate, Associate Degree or Diploma) Completed Year 12 Schooling or Equivalent Did not complete Year 12 Schooling or Equivalent Completed Year 10 Schooling or Equivalent Did not complete Year 10 Schooling or Equivalent Don t know Not applicable Which of the following classifications BEST describes your current or recent occupation? If unemployed go to next question. Manager Sales Workers Professionals Machinery Operators and Drivers Technicians and Trade Workers Labourers Community and Personal Service Workers Other Clerical and Administrative Workers What is your current employment status? Full Time Employed Part Time Employed Self-employed Not employing others Employer Employed Unpaid worker in family business Unemployed Seeking Full Time work Unemployed Seeking Part Time work Not employed Not seeking employment What is your main reason for undertaking this skills assessment? To get a job To get a better job or promotion To try for a different career I wanted extra skills for my job To develop my existing business For personal interest or self-development To get into another course of study To start my own business It was a requirement of my job Other reasons www.vu.edu.au/skilled-migration 1 July 2018 12

SECTION J Applicant s Declaration Please attach two (2) passport sized photos of yourself. Photos are to be certified in the space provided below, indicating This is a true photo of (applicant full name) and must include stamp, certifier signature and details. Please refer to the Information for Applicants Guide for photo requirements. Please do not staple. This is a true photo of (Applicant s full name) Please affix passport sized photo #1 here Please affix passport sized photo #2 here Certifier stamp, signature and details I (Applicant name) declare that: The information contained in this application is true and correct and that all documents are genuine. All evidence I have provided relates to me and my work and can be verified. I have read and understand the information supplied to me in this application. I will inform Victoria University of any changes to my details contained in this application while my application is being processed. I authorise my appointed agent or representative to act in all matters concerned with this application. I intend to apply for Permanent Migration (GSM/ENS/RSMS) / Temporary Skills Shortage (TSS) Visa. I authorise Victoria University to make any enquiries necessary to assist in the assessment of my skills including contacting training institutions, employers or other authorities, and to use any information supplied for that purpose. I authorise Victoria University to disclose my personal information to overseas subcontractors, where relevant, in order to assist in the assessment of my skills. I understand that Victoria University may verify information relating to this application with any Australian state or territory licensing or training authority. I understand that Victoria University may provide the Department of Education and Training, Department of Home Affairs or the Australian Taxation Office with any of the information contained in this application. I understand that documentation and information submitted in support of my application may be referred to the Department of Home Affairs for integrity checking. I understand that the Department of Home Affairs may, where relevant, take into account any information referred on by Victoria University in the assessment of my application for a visa. I understand that my photograph may be taken and/or videotaping/recording may occur during the technical interview. This may be used for identity check and/or for assessment moderation purposes. I acknowledge that if I undertake a practical assessment it is at my own risk and that it is my responsibility to adhere to safe work practices during the scheduled practical assessment. I acknowledge that it is my responsibility to ensure that at all times during the assessment activities that I work safely when working on my own and when working with others, and while using any tools and equipment. I agree that Victoria University and any third party providing services in respect of or hosting the assessments is not liable in respect of any personal injury, death or property damage arising during the course of the assessments. I acknowledge that I need to meet the minimum English language test requirement to gain the relevant visa and that all assessments by Victoria University will be conducted in English. Applicant s Signature Date www.vu.edu.au/skilled-migration 1 July 2018 13

SECTION K Submitting your application INSTRUCTIONS FOR APPLICANTS Victoria University prefers applications submitted electronically to the appropriate email address. Electronic applications Following these instructions in preparing/scanning your documents and ensuring your application is decision ready will assist in faster processing: All documents must be scans of original documents and scanned in colour. The minimum scan resolution is 150 dpi (dots per inch). If your documents are not in English, you will need to have them translated into English. You need to submit copies of the original documents as well as the English translations. Please note that a registered translation service must be used. Do not scan all your documents as one whole document, separate them into specific groups, i.e. Application form (altogether), employer statements (altogether), etc. The quality and authenticity of documents is paramount Save your documents as your name and the type of document, i.e. Jose DIAZ_Resume Where possible scan the Payment form separately, i.e. Jose DIAZ_Payment form Where possible save your document as a PDF, i.e. Jose DIAZ_Qualifications.pdf Applicants will be required to present original documents for verification purposes prior to Technical Assessment. Applications by post Send to the address listed below Please ensure all hard copy documents are in colour. We recommend not to send original documents. If you submit original documents, they will not be returned. Applicants will be required to present original documents for scanning and verification purposes prior to Technical Assessment. You can send your completed Application in one of the following ways to Victoria University: BY EMAIL gsm@vu.edu.au tss@vu.edu.au BY REGULAR POST Skilled Migration Assessment Services Victoria University-Sunshine Campus PO Box 14428 Melbourne VIC 8001 Australia COMMENTS If you would like to make any further comments in support of your application, please do so here BY COURIER / IN PERSON Skilled Migration Assessment Services Victoria University-Sunshine Campus 460 Ballarat Road Sunshine VIC 3020 OFFICE HOURS Monday to Friday, 9.00am 5.00pm Eastern Standard Time ENQUIRIES For all enquiries relating to this application, please contact Skilled Migration Assessment Services on: +61 3 9919 7365 WEBSITE www.vu.edu.au/skilled-migration www.vu.edu.au/skilled-migration 1 July 2018 14