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Personal Details
Title:
Gender:
Family Name:
Given Names:
Date of Birth:
Address:: Line 1:
Line 2:
City:
Country:
State:
Postal Code:
Email Address:
Home Phone:
Work Phone:
Mobile:
Emergency Contact
Name:
Relationship:
Address:: Line 1:
Line 2:
City:
Country:
State:
Postal Code:
Contact Number:
Course Title (ie. Cert IV in Business):
Are you applying for Recognition of Prior Learning?:
Date:
Signature (Print Name):
: The Department of Further Education, Employment, Science and Technology collect the required information on this form for use by the Commonwealth Department of Education, Science and Training. This information is collected for the purpose of auditing participation and the monitoring and reporting of training outcomes. The information you provide may be accessed by officers of these two departments and by the National Center for Vocational Education Research (NCVER) for the above purposes.
Additional Details
In which country were you born?:
If Other, Please Specify:
Do you speak a language other than English at home?:
If Other, Please Specify (If more than one language, indicate the one that is spoken most often):
How well do you speak English?:
Are you of Aboriginal or Torres Strait Islander origin?:
Do you consider yourself to have a disability, impairment or long-term condition?:
If YES, then please indicatethe areas of disability, impairment or long-term condition (You may indicate more than one area):: Hearing/DeafPhysicalIntellectualLearningMental IllnessAcquired Brian ImpairmentVisionMedical ConditionOther
What is your highest COMPLETED school level?:
In which YEAR did you complete that school level?:
Are you still attending secondary school?:
Have you SUCCESSFULLY completed any of the following questions? (Mark any applicable boxes):: Bachelor Degree or Higher DegreeAdvanced Diploma or Associate DiplomaDiploma (or Associate Diploma)Certificate IV (Or Advanced Certificate/Technician)Certificate III (Or Trade Certificate)Certificate IICertificate ICertificates Other then Above
Of the current categories, which BEST describes your current employment status?:
Your Major Reason for Study?:: Get a JobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self-developmentOther reasons

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