Enrolment Form 1 Course Details2 Personal Details3 Unique Student Identifier4 Background5 Next of Kin6 Education & Employment7 Identification8 Concession9 Student Declaration & Acknowledgement UntitledThe information contained in this form is used for enrolment and statistical purposes; to assist in research and evaluation by relevant government agencies and Core Industry Training.Funding ModePlease select your funding mode*Construction Skills QueenslandCertificate 3 GuaranteeUser Choice (Apprentice Funding)Fee for ServicePlease contact us for eligibility information.1. COURSE DetailsCourse Name*Please select your qualificationAHC20416 Certificate II in HorticultureAHC30616 Certificate III in Production HorticultureAHC30916 Certificate III in Landscape ConstructionAHC31016 Certificate III in Parks and GardenAHC31416 Certificate III in Conservation and Land ManagementAHC32816 Certificate III Rural OperationsCPC10111 Certificate I in ConstructionCPC20712 Certificate II in DrainageCPC30211 Certificate III in CarpentryCPC40110 Certificate IV in Building and Construction (Building)CPC50210 Diploma of Building and Construction (Building)FSK10213 Certificate I in Skills for Vocational PathwaysFSK20113 Certificate II in Skills for Work and Vocational PathwaysMEM20413 Certificate II in Engineering PathwaysMSF10113 Certificate I in FurnishingMSF20516 Certificate II in Furniture Making PathwaysMSMWHS217 Gas test atmospheresRIICOM201D Communicate in the workplaceRIIHAN301D Operate elevating work platformRIIMPO317E Conduct roller operationsRIIMPO318E Conduct civil construction skid steer loader operationsRIIMPO320E Conduct civil construction excavator operationsRIIMPO321E Conduct civil construction wheeled front end loader operationsRIIWHS201D Work safely and follow WHS policies and proceduresRIIWHS202D Enter and work in confined spacesRIIWHS204D Work safely at heightsRIIWHS205D Control traffic with stop-slow batRequest for RPL*YesNoRequest for Credit Transfer*YesNoUpload supporting documentationAccepted file types: jpg, gif, png, pdf.Speed up your enrolment processing time by uploading your Credit Transfer supporting documentation now.Could you please tell us how you heard about Core industry Training in general and about this course, in particular.* Save and Continue Later (please check your junk mail if you can't find the email) 2. Personal DetailsPlease write your name as it appears for your identification documentation and your USI including any middle names. If you do not have a USI yet, please see the USI part of this enrolment form.First and Middle Name/s*Last Name*Date of Birth* dd/mm/yyyyGender*MaleFemaleOtherUsual Residential Address Not a PO Box. Building/Property name is the official place, name or common usage for a site including the name of a building, complex, farms, park or unbounded address site.Address*Suburb*Postcode*State*QLDNSWACTVICTASSAWANTPostal Address If different to residential address.P.O. Box Number / Street Name/NumberSuburb, State and PostcodeContact Details Preferred Contact Method*Home PhoneMobile PhoneEmailEmail*Phone Number (Home)Phone Number (Mobile)* Save and Continue Later (please check your junk mail if you can't find the email) 3. Unique Student IdentifierFrom 1 January 2015, Core Industry Training can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are required to include your USI in the data we submit to NCVER. Information about the Unique Student Identifier System can be viewed at www.usi.gov.au Do you have a USI?*YesNoMy USI Number is:*USI Creation*I will create my own USIRequest Core Industry Training to find or generate USI on your behalfCreate a USI number at www.portal.usi.gov.au/studentComplete the following fields. (Note: You can retrieve forgotten USIs via https://www.usi.gov.au/faqs/i-have-forgotten-my-usi-what-can-i-do)If you want to us to find or create your USI for you, do you authorise Core to create a USI on your behalf?*YesNoTo continue your enrolment you will need to either create your own USI or authorise Core Industry Training to create a USI on your behalf. To give authority for Core Industry Training to create a USI for you, please change your answer to this question to "Yes". To create your own USI, visit the site below and then add your USI to this form by selecting "Yes" for the question "Do you have a USI?" Create your USI here: https://www.usi.gov.au/students/create-your-usiTown and Country of Birth*ID Type submitted with this application for USI*Driver LicenseMedicare CardAustralian PassportBirth Certificate (Australian)Visa (Non-Australian Passport)Citizenship CertificateCertificate of Registration by DescentID/license Number*Please attach a copy of the identification as a colour scan or photograph and attach to this enrolment formAccepted file types: jpg, gif, png, pdf.Speed up your enrolment processing time by uploading your identification documentation now. Save and Continue Later (please check your junk mail if you can't find the email) 4. CULTURAL, LANGUAGE AND LITERACY BackgroundAre you Aboriginal and/or Torres Strait Islander?*No, Neither Aboriginal nor Torres Strait IslanderYes, AboriginalYes, Torres Strait IslanderYes, Aboriginal and Torres Strait IslanderCountry of Birth*AustraliaNew ZealandAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweWhat is your Citizenship Status*Australian CitizenPermanent Resident of AustraliaNew Zealand CitizenOverseas ResidentVisa HolderIs English your first spoken language?*YesNoDo you speak any other languages other than English at home?*NoYesWhat Languages(s) are spoken at home?*Do you have a disability, impairment or long-term health condition?*No disabilityHearing/deafMental IllnessIntellectualMedical ConditionAcquired Brain ImpairmentPhysicalVisionLearningFor additional information to assist with answering this question, please visit here: https://coreindustrytraining.edu.au/disability-supplement/Do you require any assistance with the above?*YesNoPlease advise so we can call you prior to your course starting to discuss your needs.Will you require any assistance with Literacy or Numeracy?*YesNoPlease let us know so we can contact you to discuss your needs prior to starting the course. Save and Continue Later (please check your junk mail if you can't find the email) 5. Next of Kin DetailsNameRelationshipBest Contact NumberAlternative Contact Number Save and Continue Later (please check your junk mail if you can't find the email) 6. EDUCATION DetailsAre you currently attending High School?*YesNoIf yes, what grade are you in?*Name of school you are attending*What is your Highest Level of School Completed?*Did not go to schoolYear 8 or belowCompleted Year 9 or equivalentCompleted Year 10 or equivalentCompleted Year 11 or equivalentCompleted Year 12 or equivalentOtherThe year you completed this.Your highest level of qualification*No additional qualificationsCertificate ICertificate IICertificate IIICertificate IVDiplomaAdvanced DiplomaBachelor's DegreeDoctorateMiscellaneousName of Highest QualificationYear CompletedHave you started a Qualification but not completed it?*YesNoWhat Level of Qualification was the qualification you started?*Certificate ICertificate IICertificate IIICertificate IVDiplomaAdvanced DiplomaBachelor's DegreeDoctorateMiscellaneousName of Qualification*Subjects Completed*YesNoHave you withdrawn from the course?*YesNoQualification Upload Drop files here or Accepted file types: jpg, gif, png, pdf. Please attach copy of Certificate with list of units achieved (transcript) and/or statement of attainment. You can upload multiple files here.Employment Status DetailsWhich of the following best describes your current employment statusEmployerFull time employeePart time employeeSelf Employed but not employing othersUnemployed seeking full time workUnemployed seeking part time work Save and Continue Later (please check your junk mail if you can't find the email) 7. IDENTIFICATION DocumentationYou will need to provide documentation to verify identify and met the requirements of any funding you are applying for. Please upload these documents with this enrolment form. Please provide colour copies only please.Proof: Date of Birth*Driver's Licence (front)Current Australian or New Zealand PassportBirth CertificatePlease upload your proof of Date of BirthSpeed up your enrolment processing time by uploading your Identification documentation now.Proof of Citizenship/Residency Status*Green Medicare CardCurrent Australian or New Zealand PassportAustralian Citizenship CertificatePlease upload your proof of Citizenship/ResidencySpeed up your enrolment processing time by uploading your Identification documentation now.Proof of Address (Qld only if funded)Queensland Drivers Licence (back)Current bills/rates noticeCurrent bank statementsPlease upload your proof of AddressSpeed up your enrolment processing time by uploading your Identification documentation now.Reason for StudyingWhat best describes your reason for undertaking this course?*To obtain employmentTo develop my existing skillsTo start my own businessTo change CareersTo improve my job ProspectsTo obtain a promotionThe qualification is a requirement of my jobPersonal interestTo progress into another course of study Save and Continue Later (please check your junk mail if you can't find the email) 8. Concession Fee EligibilityWhat concession type do you hold?*I don't qualify for a concessionI hold a current Healthcare concession or pensioner cardI am an Aboriginal or Torres Strait Islander personMy Card No:Please upload your proof of Concession Fee Eligibility (if applicable) Drop files here or Accepted file types: jpg, gif, png, pdf. Speed up your enrolment processing time by uploading your concession fee eligibility documentation now. Save and Continue Later (please check your junk mail if you can't find the email) 9. STUDENT DECLARATION & AcknowledgementStudent DeclarationCertificate 3 Guarantee Program* I confirm I have read terms and conditions below I do not hold, nor am I currently undertaking a Certificate III level or higher qualification with another training organisation. (With the exception of Certificate II qualifications completed at high school) I am 15 years of age or older and no longer at school I am an Australian/New Zealand citizen or a Permanent Resident Visa Holder. I am a refugee/humanitarian Visa Holder or a temporary resident on a demonstrated pathway to Permanent Residency. I permanently reside in Queensland. I am aware that after I complete this qualification, I will no longer be eligible for subsidized training at a Certificate III level through this program. I understand that I am required to make a co-contribution to participate in this training. I have formally withdrawn from all previous ‘funded’ courses, and I have notified the other Training Organisation. If required, I can provide a Statement of Attainment to show all results of these studies. User Choice Funding (Apprenticeships)* I confirm I have read terms and conditions below I do not hold, nor am I currently undertaking a qualification as part of an apprenticeship where I have accessed User Choice funding at the same level or higher. I am 15 years of age or older (minimum ages vary for apprenticeships) I am an Australian/New Zealand citizen or a Permanent Resident Visa Holder. I permanently reside in Queensland. I understand that I am required to make a co-contribution to participate in this training. I have formally withdrawn from all previous ‘funded’ courses, and I have notified other RTO’s of this. If required, I can provide a Statement of Attainment to show all results of my previous studies.Fee for Service* I confirm I have read terms and conditions below I can provide a Statement of Attainment for any previously completed studies. I am an Australian/New Zealand citizen studying in Australia or an overseas resident studying in Australia.Construction Skills Queensland (CSQ)* I confirm I have read terms and conditions below I acknowledge that I have been advised and understand the requirements of the qualification I have enrolled in. I understand that I must provide all eligibility documentation before commencing training and that Core Industry Training reserve the right to terminate my enrolment and re-allocate my position should I not make reasonable progress through my course during the term of the contract. I am an Australian/New Zealand citizen, a Permanent Resident Visa Holder or a refugee/ humanitarian Visa Holder I permanently reside in Queensland. I am permanently employed within the building/construction industry in Queensland I am an Eligible, Existing or Unemployed Eligible Worker as per the eligibility requirements in the Building and Construction Industry (Portable Long Service Leave) Act 1991. I am an Apprentice (3rd or 4th year) – Certificate IV qualifications only I am not an employee of any Authority (excluding employees of Indigenous Councils that are principal contractors) I am not currently enrolled in a Queensland secondary school or a contracted trainer/assessor for an RTO. I am not funded by an Authority of other source for this training I understand that CSQ funding is available for a limited term. I consent for my details to be provided to CSQ for the purposes of (but not limited to) a review, conducting participant surveys or being contacted for the purposes of advise regarding CSQ products and services.Student AcknowledgementStudent Acknowledgement* I acknowledge that: I confirm the accuracy of the information provided; I give my permission for Core Industry Training to act on my behalf to contact ASQA or any Registered Training Organisation I have been previously enrolled with to obtain information about my enrolment status and past academic results (i.e. withdrawal and/or Statement of Attainment). Any fees charged by the other RTO/s will be my expense. I have read and understood the Core Industry Training Handbook including the Refund and Complaints Policies and Processes. I acknowledge this is available at www.coreindustrytraining.edu.au at all time for my reference. I understand that my training may be delivered by a Core Industry Training approved on Core Industry Trainings’ behalf. I consent to the disclosure of my details by the RTO to government agencies as required. Please read the Privacy Notice and Student Declaration. I will abide by my own responsibilities as a student of Core Industry Training as outlined in the Student handbook. I have received and understood the terms and conditions of enrolment. I will fill out and return a Student Survey following the completion of my qualification. I have been informed of how my training and assessment will be conducted. I declare that all the information provided in this enrolment is true and correct and I am aware that consequences that may occur for providing false, misleading or incomplete information may be cancellation of my enrolment or withdrawal of any offer made by Core Industry Training. Signature*Please sign on the screen as accurately as possibleSignature of Parent or GuardianRequired for students under 18 years of age.Date Save and Continue Later (please check your junk mail if you can't find the email) This iframe contains the logic required to handle Ajax powered Gravity Forms.