Success Resources Online Learning Enrolment Form by lindahy

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									                                              Success Resources Online Learning
                                                       Enrolment Form
                                    IMPORTANT: To enrol in this online course, you must submit this Enrolment Form to the address at
                                                        the bottom of this form. ALL field must be completed.




         Please print in boxes using only BLOCK letters and TICK boxes or CIRCLE where applicable.

Have you ever previously enrolled for a Course/Traineeship with Success Resources?                                Yes                 No
I have arranged for my supervisor to be:
Name:                                                         Supervisor’s name:
Supervisor’s email:
I wish to enrol in:
              Queensland Sales License Course                                      Queensland Dealer Licence Course
Cert II              Cert III              Cert IV             Diploma               in: (insert name
                                                                                        of Course)

Through:
RPL/Coursework                      Desk Audit              Single Unit              (Insert Unit Code
                                                                                         and Title)

1. Personal Details
Family Name:                                                                        Date of Birth:
Given Names:                                            Preferred Name:                             Gender:        M              F
Home Address (Number and street):
Town/Suburb:                                                         State:                         Postcode:
Telephone (Home):               (         )                                          Mobile:
Email:
Please note: It is important that you provide an accurate, working email address as this is our main contact with you for the course.

2. Employment
Not presently employed
Workplace:
Workplace address:                                                                Suburb/Town:
State:                                         Postcode:                                    Phone:

Employee’s Job description:
Date Employment Commenced:                                                     Hours worked per week:
Of the following categories, which best describes your current employment status? (Please tick one box only)
Full-time employee                   Part time employee              Casual employee                     Contract employee




                                                Success Resources International
              PO Box 1121 Springwood QLD 4127 P 07 3290 1133 F 07 3290 1233 E office@successresources.com.au
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3. Education Details
Have you successfully                                      Degree               Diploma              Advanced Certificates
completed any of the
following qualification?            Cert III/Trade Certificates              Cert I or II                                 Other

If so, please specify the                                                       In what year did you
name of the qualification                                                       obtain your
                                                                                qualification?

Are you still attending       Yes               What is our highest                         In what year did you
 secondary school?             No             completed school level?                       complete this level?

4. Funding / Statistical Information
Were you born in Australia?           Yes             No            If no, where were you born?
Do you identify as Aboriginal or Torres Strait Islander?                                          Yes                    No
Are you an Australian Citizen?                                                                    Yes                    No
Are you an Australian Resident?                                                                   Yes                    No
Do you speak a language other than English at home?                                               Yes                    No
If yes, which language?
Do you consider yourself to have a disability, impairment or long-term condition?                 Yes                    No
Provide details:

5. Student Declaration
    •     I have read and understood the SRI Refund Policy located in the SRI Training Handbook
    •     I have read and understood the SRI Code of Practice located in the SRI Training Handbook.
    •     I undertake to abide by the requirements of my Training Plan and to maintain regular
          communication with my tutor and supervisor.
    •     Confirm that all the information provided by me on this form is true and accurate.

Employee Signature:                                                                      Date:

6. Funded students only. This section to be completed by Employer
Business Name:
Address:
Suburb/Town:                                                                             Postcode:
Phone:                                                                            Fax:
Email:
I hereby endorse this enrolment application and undertake responsibility for payment.

Employer Signature:                                                                      Date:

    Privacy Statement: Information relating to this enrolment shall NOT be made available to any party, other than those directly
                            responsible for the administration of the course, the client and the Employer




                                                Success Resources International
              PO Box 1121 Springwood QLD 4127 P 07 3290 1133 F 07 3290 1233 E office@successresources.com.au
         Version 1.0/ Success Resources Online Learning Enrolment Form.doc                                                  2
6. Payment Details (Non-funded students only)

  Electronic Funds Transfer (EFT)                                     Remittance advice must be forwarded to ensure
ANZ Brisbane         BSB: 014 002                                     payment is recorded accurately
Account Number:      1096 36205
Account Name:        Success Resources                                Please forward Remittance Advice to:
                     International Pty Ltd
                                                                                 Fax:     07 3290 1233
Please note: Over the counter transactions may be                                E: office@successresources.com.au
made at any ANZ branch.
    Cheque* payable to:
                                                                      * All cheque payments will be subject to
Success Resources International Pty Ltd                               clearance/approval
PO Box 1121, SPRINGWOOD, QLD 4127
                                                                      Payment for:
Payment amount:           $                                           QLD Sales Licence                 QLD Dealer Licence
                                                                      Certificate II                    Certificate III
                                                                      Certificate IV                    Diploma
                                                Payment is for:         Admin Fee ($90)
                                                                                                        (Attracts discount of $90 Admin Fee)
                                                                            Full course
                                                                      Desk Audit              Single Unit            Study Period 1



Office Use Only

Funding type:
Course Title:
Nominal Duration:



Personal information is collected from you for the purpose of obtaining and verifying student related details. For further information on
the SRI Privacy Policy please go to the SRI Training Handbook or www.successresources.com.au




               Please complete the Language, Literacy and Numeracy Checklist that follows.




                                               Success Resources International
             PO Box 1121 Springwood QLD 4127 P 07 3290 1133 F 07 3290 1233 E office@successresources.com.au
        Version 1.0/ Success Resources Online Learning Enrolment Form.doc                                                             3
                Language, Literacy and Numeracy Checklist
In order that Success Resources can offer you the best support available, we ask you to complete this
short language, literacy and numeracy assessment to help us understand how we can assist you. This
information will be treated as confidential.


For the following statements, please indicate your response by ticking Yes, No or Unsure.
                                                                                   YES           NO          Unsure
I can read and understand the documents I use in my workplace

I find it easy to complete forms and written reports.

When completing a written task, it helps me to have someone with me.

I feel confident speaking at workplace meetings.

In my workplace, I find it easy to complete tasks involving addition,
subtraction, multiplication and division.
In the space below, please write a paragraph explaining your role and describing the tasks you
complete in you workplace.




Please read the following statements and circle what you believe to be is the correct answer
Which of the following fractions is equal to 75%?                       5/8        6/9       3/4

If you ran 1.8 kilometres a day, how many kilometres would have run                7.8            9              9.6
over a 5 day period?
If a person earns $20 per hour, how much are they paid for a) an 8               a) $200        $120          $160
hour day and b) for a 40 hour week?                                              b) $800        $600         $1100
Jack is 13 years older than his sister who is 49. How old is Jack?                  62           65            67

19 people out of 30 voted “No” in a survey. How many people voted                   9            13              11
“Yes”?



                             Thank you for your time in completing the above.




                                              Success Resources International
            PO Box 1121 Springwood QLD 4127 P 07 3290 1133 F 07 3290 1233 E office@successresources.com.au
       Version 1.0/ Success Resources Online Learning Enrolment Form.doc                                     4

								
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