Enrolment Application

Fee for Service | RTOFM002 V29

PLEASE WRITE CLEARLY SO WE CAN READ IT, SO THERE ARE NO DELAYS FOR YOU — THANK YOU.

Course Information

Today's Date *

Unit / Qualification

Personal Details

Title *

Mr Ms Miss Mrs

Gender *

Male Female Indeterminate / Intersex / Unspecified Non-Binary Different term

First Name *

Middle Name

Last Name *

Previous Name

Date of Birth *

Suburb / Town of Birth

Contact Details

Home Phone

Mobile Phone *

Email Address *

Emergency Contact Details (Must be parent or guardian if student is under 18)

Emergency Contact Name *

Emergency Contact Phone *

Relationship *

Parent Guardian Other

Please specify relationship

Residential Address

Number and Street Name *

City / Town *

State *

Post Code *

Postal Address (if different from above)

PO Box Number

City / Town

Post Code

Preferred Contact Method

Email Mail Phone

Residential Status

Are you an Australian Citizen or Permanent Resident of Australia? *

Yes No

If No, please specify your visa / residency status

Aboriginal and/or Torres Strait Islander Status

Are you of Aboriginal or Torres Strait Islander origin? (For persons of both origins, tick both Yes boxes.)

No Yes, Aboriginal Yes, Torres Strait Islander

Country of Birth & Language

In which country were you born? *

Australia Other

Do you speak a language other than English at home? (If more than one, indicate the most spoken.)

No, English only Yes, other

Please specify language

How well do you speak English?

Very well Well Not well

Secondary Education

Are you still attending secondary school?

Yes No

LUI Number

What is your highest COMPLETED school level? (Select ONE)

Completed Year 12 Completed Year 11 Completed Year 10 Completed Year 9 or Equivalent Completed Year 8 or Lower Never attended school

Year of completion

Prior Education

Have you successfully COMPLETED or are you currently enrolled in any of the following qualifications?

No Yes

Select all that apply:

Certificate I Certificate II Certificate III Certificate IV Diploma Advanced Diploma Bachelor's Degree Certificate other than the above

Main Reason for Study

Which BEST describes your main reason for undertaking this course? (Select ONE)

To 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

Employment Status

Which BEST describes your current employment status? (Select ONE)

Unemployed – Seeking Full-time Work Unemployed – Seeking Part-time Work Full-time Employee Part-time Employee Employed – Unpaid Worker in a Family Business Not Employed – Not Seeking Employment Self Employed – Not Employing Others Employer

Medical Condition / Disability

Do you consider yourself to have a disability, impairment, or long-term medical condition?

No Yes

Select all that apply:

Medical Visual Hearing Learning Intellectual Physical Other

If Other, please specify:

Medical Disclosure

Please disclose whether you suffer from a medical condition to help us create a safer learning environment for you.

Have you been medically diagnosed with Anaphylaxis?

No Yes

Do you have your action plan and Epi/Ana Pen on your person at all times?

No Yes

Have you been medically diagnosed with Epilepsy?

No Yes

Have you been medically diagnosed with Asthma?

No Yes

Do you have any other allergies or intolerances?

No Yes

Please specify:

Do you have any other type of medical condition?

No Yes

Please specify:

Additional Support

Do you feel you will need extra assistance/support from your trainer to complete this course?

No Yes

Please specify the type of assistance you may need:

Recognition of Prior Learning (RPL)

Do you wish to apply for RPL for this qualification based on your previous experience?

No Yes

Credit Transfers

Based on your previous study, do you believe you are eligible to apply for credit transfers?

No Yes

Employer Details

Employer Name

Position / Job Title

Unique Student Identifier (USI)

Have you previously been issued with a USI?

Yes No

Enter your USI (10 characters)

Would you like Jenagar to create a USI on your behalf?

A copy of identification MUST be supplied to create a USI. Please discuss with Jenagar.

Yes No

National Unique Student Identifier Privacy Notice

You are advised that and agree that you understand and consent that the personal information you provide in connection with an application or a verification for a USI:

Is collected by the Registrar as authorised by the Student Identifiers Act 2014
Is collected by the Registrar for the purposes of: 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 Commonwealth and State/Territory government departments and agencies; VET Regulators; VET Admission Bodies; current and former Registered Training Organisations; Schools; the National Centre for Vocational Education Research; and Researchers for education and training related research purposes.
Will not otherwise be disclosed without your consent unless authorised or required by law.

The Student Identifiers Registrar's Privacy Policy is located at www.industry.gov.au.

I have read the Unique Student Identifier Privacy Notice and agree to allow Jenagar to apply or verify a Unique Student Identifier on my behalf.

Student Name (print) *

Date *

I confirm that I have read and understood the USI Privacy Notice above and consent to Jenagar applying or verifying a USI on my behalf. *

Parental Permission (Applicants Under 18 Years of Age)

I have read and understood the terms and conditions of this application for enrolment and give permission to continue with this enrolment and course.

Parent / Guardian Name

Date

I (parent/guardian) give permission for this enrolment to proceed (only required if student is under 18).

Policies

Privacy Statement

Privacy and all personal information are protected under the Privacy Act 1988. The information requested on your enrolment form will be used for the process of enrolment and for statistical reporting for government agencies only. All information is kept confidential and access to this information is only available to you, and the relevant administration staff at Jenagar Pty Ltd. Jenagar is subject to audit by Government agencies. For the purpose of these audits your training file may be given to officers from agencies such as Australian Skills Quality Authority (ASQA) or the National VET Regulator (NVR).

If you have concerns about personal information held by Jenagar Pty Ltd, contact us on (07) 4787 1487 or write to: The Manager, Jenagar Pty Ltd, PO Box 1905, Charters Towers, QLD 4820. Alternatively, contact the Commonwealth Privacy Commissioner, GPO Box 5218, Sydney NSW 2001, Telephone: 1300 363 992 or email: privacy@privacy.gov.au.

Complaints Policy

Complaints can be made informally or formally. Contact Jenagar in the first instance and it will be investigated. You will receive a written response within 7 days of the receipt of your formal complaint. All records of complaints and investigations will be kept on file.

Refund Policy

Students who have already paid for a course can ask for a refund in the event of: services not being provided (e.g., course cancellation); the financial failure of Jenagar Pty Ltd; or the fair and reasonable non-attendance of a student (e.g., sickness, family emergency). Jenagar Pty Ltd will also negotiate a fair and reasonable level of refund in other circumstances. Please request a copy of the Jenagar Pty Ltd Refund Policy for more information.

Student Declaration and Acceptance Agreement

I understand and acknowledge that:

I acknowledge that providing any false information and/or failing to disclose any information relevant to my application for enrolment and/or failure to complete an application/enrolment form may result in the withdrawal of any offer, particularly where it relates to my eligibility to obtain an offer for government subsidised training, and/or cancellation of enrolment at the discretion of Jenagar.

I understand that it is my responsibility to provide all relevant documentation required for my enrolment in a course, including all documentation relevant to my eligibility for government funding, for the Recognition of Prior Learning (RPL) and/or for any Credit Transfers to be applied.

Declaration:

I declare that the information provided to Jenagar in this Enrolment Application is to the best of my knowledge true, correct, and complete at the time of my enrolment.

I indemnify Jenagar Pty Ltd from any claim or action and for any liability, other than legislative requirements with which Jenagar must comply, which may arise or occur as a result of participation in this training.

I understand and accept the fees, charges and refunds that may be applied to this enrolment and the circumstances in which they apply.

I have been provided with a copy of the Student Handbook and the contents have been explained to me.

Student Name (print) *

Date *

I declare that all information provided is true and correct, and I accept the terms and conditions above. *

Consent and Release — Marketing & Promotional Material

Like any business, Jenagar are involved in marketing and promotional activities. Throughout your course, we will collect and prepare material that may include photos of our students, testimonials, and comments or statements made by students on our Facebook page. This material may be reproduced for any promotional purpose in accordance with our Privacy Policy.

By ticking the box below, you consent to Jenagar: taking your photo and reproducing it for promotional purposes (publications, website, Facebook, social media); using any testimonial or comment which you may give or post; and you agree to release Jenagar from any claim in respect of the reproduction of your photo, testimonial or post.

Student Name (print) *

Date *

I consent to Jenagar using photos, testimonials and social media comments for marketing and promotional purposes.

Parent / Guardian Consent (if student is under 18)

Parent / Guardian Name

Date

I (parent/guardian) consent to Jenagar using my child's photos and testimonials for marketing purposes.

Language, Literacy & Numeracy Assessment

Please answer the following questions to the best of your ability.

Student Name

Date

Question 1: You are driving a vehicle travelling at 100kph. You pass a sign that states you are 50km from your destination. If you continue at your current speed, how long will it take to arrive?

a. 25 minutes b. 30 minutes c. 35 minutes

Question 2: "Manual Handling" means:

a. Driving a manual vehicle b. Lifting, load carrying, setting down or movement of goods with the aid of machinery c. Lifting, load carrying, setting down or movement of goods without the aid of machinery

Question 3: Which of the following is NOT a form of written communication?

a. Telephone b. Email c. Letter d. Fax

Question 4: A service station sells 10 litres of motor oil for $20.00, and 6 litres for $12.50. Which is the better value?

a. 10 litres b. 6 litres

Question 5: List three areas in your workplace where cleanliness & tidiness duties would be performed:

Area 1

Area 2

Area 3

Question 6: Four managers have been invited by a chairperson to attend a state conference. They were requested to bring an employee with them. All four managers attend, but only three bring an employee. Including the chairperson, how many people attend this conference?

a. 9 b. 8 c. 7

Question 7: When would you expect an "Induction Program" to be carried out?

a. At the start of their employment b. In the middle of their employment if they are not performing well enough c. At the completion of their employment

✓ Thank you! Your enrolment application has been submitted successfully.

The Jenagar team will be in contact shortly to confirm your enrolment details.