Enrolment Form - HRTC Powered by EzyLearn by wuzhenguang

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									                                 Harness Racing Training Centre
                                     Course Enrolment Form

COURSE:
Surname:

Given Name:

Date of Birth:                               Sex: Female                       Male

Current Address:

Street & No

Town
Postcode

Phone No:

Emergency Contact:        Name

                      Phone No

Of the following categories, which BEST describes your current employment status?
(tick one box)

   Full time employee                               Employed – unpaid family worker
   Part time employee                               Un employed – seeking full time work
   Self employed – not employing others             Un employed – seeking part time work
   Employer                                         Un employed – not seeking work

What is your highest COMPLETED school level? (tick one box)

Year 12 or higher         Year 11         Year 10                  Year 9 or lower

In which YEAR did you complete that school level?

Are you still attending secondary school? (tick one box)           Yes                   No

Since leaving school have you completed any qualifications?

(tick one box)      Yes          No

If YES, then tick ANY applicable boxes.
   Bachelor Degree or Higher Degree                 Certificate III (or Trade Certificate)
   Advanced Diploma or Associate Degree             Certificate II
   Diploma (or Associate Diploma)                   Certificate I
   Certificate IV (or Advanced                      Certificates other then above
   Certificate/Technician

Were you born in Australia? (tick one box)     Yes                    No

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   If NO, in which country were you born?

   Are you of Aboriginal or Torres Strait Islander origin?
   No
   Yes, Aboriginal
   Yes, Torres Strait Islander

   Do you speak a language other than English at home?
   (Please indicate the language that is spoken most often)
   No, English only
   Yes, Other – Please specify

   How well do you speak English?

           Very well                                     Not well
           Well                                          Not at all

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

    (tick one box) Yes                    No

   If YES, then tick ANY applicable boxes.

           Hearing/Deaf                                  Acquired Brain Impairment
           Physical                                      Vision
           Intellectual                                  Medical Condition
           Mental Illness                                Other

   At the end of this course, what do you expect to have achieved?

           Improved work skills                          Updated existing knowledge
           Improvement of general                        Employment entry level skills
           knowledge
           Improved promotional prospects                Other, please explain
           Increased employment
           opportunities


   Student Signature:            ________________________________________________

   Date:                         ________________________________________________


OFFICE USE ONLY:

 Student                                             Course
 No                                                  Code
 New Apprenticeship          Short Course program        Program subsidised                DETYA funded
 (OTFE Funded)               Fee for service             under PETP                        Pre-employment
                                                                                            program




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