OSCA 2017 - Enrolment Form - Cert III in Surface Extraction Operations

• Document No.

• Participant's Name:

• Client / Site:

• Instructor's Name:

• Conducted on:

  Date

Student Details

• Title?

  Mr

  Miss

  Mrs

  Ms

  Others

• Surname (Legal Family Name)?

• Given Legal Name/s?

• Gender?

  Male

  Female

• Date of Birth?

• Address

• Number and street address?

• Suburb?

• State?

  Select Queensland New South Wales Victoria South Australia Western Australia Northern Territory ACT Other

  • Queensland
  • New South Wales
  • Victoria
  • South Australia
  • Western Australia
  • Northern Territory
  • ACT
  • Other

• GO MAROONS!!!!

  

• Inform your instructor now! You may not be eligible for government funding for this course.

• Post Code?

• Country (if not Australia)?

• Is your postal address the same as the address above?

  No

  Yes

• Address / PO Box?

• Suburb?

• State?

• Post Code?

• Contact Phone Number?

• Email Address?

• What is your Unique Student Identifier (USI)? (You can't proceed with this course until you obtain one. Go to https://www.usi.gov.au)

Emergency Contact Details

• Emergency Contact Name?

• Relationship to student?

• Contact Phone Number?

• Email Address?

Personal Details

• Are you from a non-English speaking background?

  Yes

  No

• How well do you speak English?

  Very Well

  Well

  Not Well

  Not at all

• What is your usual language?

• Were you born in Australia?

  No

  Yes

• In which country were you born?

• What year did you arrive in Australia?

• Are you of Aboriginal or Torres Strait Islander origin?

  No

  Yes-Aboriginal

  Yes-Torres Strait Islander

  Yes-Aboriginal AND Torres Strait Islander

• Do you have any disabilities, impairments or long term conditions?

  Yes

  No

• Which ones?

  Select Hearing Vision Physical Learning Mental Illness Acquired Brain Impairment Medical Condition Other

  • Hearing
  • Vision
  • Physical
  • Learning
  • Mental Illness
  • Acquired Brain Impairment
  • Medical Condition
  • Other

• Do you believe you might need assistance with reading, writing, arithmetic or other areas that may make it difficult for you to complete this course?

  Yes

  No

• Do you required advice or assistance support for any of these?

  Yes

  No

• Photos: We need proof that you are a permanent resident of Qld.

• Photo (Head and Shoulders)

  Media

• Photo of proof of Qld. residency: (Front and back of Driver's License, passport, Utility Bill etc...)

  Media

• Photo of Medicate card

  Media

• Photo of Concession/Health Care Card: (If applicable)

  Media

• Employment Status:

  Select Full time employee Employer Self employed Employed (unpaid family work) Part time employee Unemployed (seeking full time work) Unemployed (seeking part time work) Not employed (not seeking employment) Other

  • Full time employee
  • Employer
  • Self employed
  • Employed (unpaid family work)
  • Part time employee
  • Unemployed (seeking full time work)
  • Unemployed (seeking part time work)
  • Not employed (not seeking employment)
  • Other

• Employer?

• List Other:

Education

• Indicate the main reason for studying this course.

  Select (01) To get a job (02) to develop my existing business 03) To start my own business (04) To try a different career (05) To get a better job or promotion (06) It was a requirement of my job (07) I wanted extra skills for my job (08) To get into another course or study (11) Other reasons (12) For personal interest or self development

  • (01) To get a job
  • (02) to develop my existing business
  • 03) To start my own business
  • (04) To try a different career
  • (05) To get a better job or promotion
  • (06) It was a requirement of my job
  • (07) I wanted extra skills for my job
  • (08) To get into another course or study
  • (11) Other reasons
  • (12) For personal interest or self development

• Have you successfully completed a qualification in the past?

  Yes

  No

• Indicate which of the following qualifications you have SUCCESSFULLY COMPLETED (only indicate those that are recognized in Australia)

  Select Bachelor Degree or Higher Degree Advanced Diploma or Associate Degree Diploma or Associate Diploma Certificate IV or Advanced Certificate Certificate III Certificate II Certificate I Other Certificates

  • Bachelor Degree or Higher Degree
  • Advanced Diploma or Associate Degree
  • Diploma or Associate Diploma
  • Certificate IV or Advanced Certificate
  • Certificate III
  • Certificate II
  • Certificate I
  • Other Certificates

• What is the highest qualification that you currently hold? (include full title of qualification, eg. Certificate III in Aged Care, VCE, IB, VCAL Intermediate,Year 10)

• In which year did you complete the highest qualification you hold?

  Select 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969

  • 2015
  • 2014
  • 2013
  • 2012
  • 2011
  • 2010
  • 2009
  • 2008
  • 2007
  • 2006
  • 2005
  • 2004
  • 2003
  • 2002
  • 2001
  • 2000
  • 1999
  • 1998
  • 1997
  • 1996
  • 1995
  • 1994
  • 1993
  • 1992
  • 1991
  • 1990
  • 1989
  • 1988
  • 1987
  • 1986
  • 1985
  • 1984
  • 1983
  • 1982
  • 1981
  • 1980
  • 1979
  • 1978
  • 1977
  • 1976
  • 1975
  • 1974
  • 1973
  • 1972
  • 1971
  • 1970
  • 1969

• Please indicate the number of Government subsidised courses you have commenced or are scheduled to commence?

  Select 0 1 2 3 4 5 6 7

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7

• Are you a full time student at a Secondary School?

  Yes

  No

• What is the highest level you have Successfully COMPLETED at Secondary School?

  Select Year 12 Year 11 Year 10 Year 9 Year 8 or lower Did not go to School

  • Year 12
  • Year 11
  • Year 10
  • Year 9
  • Year 8 or lower
  • Did not go to School

• In which year did you complete that school level?

  Select 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969

  • 2015
  • 2014
  • 2013
  • 2012
  • 2011
  • 2010
  • 2009
  • 2008
  • 2007
  • 2006
  • 2005
  • 2004
  • 2003
  • 2002
  • 2001
  • 2000
  • 1999
  • 1998
  • 1997
  • 1996
  • 1995
  • 1994
  • 1993
  • 1992
  • 1991
  • 1990
  • 1989
  • 1988
  • 1987
  • 1986
  • 1985
  • 1984
  • 1983
  • 1982
  • 1981
  • 1980
  • 1979
  • 1978
  • 1977
  • 1976
  • 1975
  • 1974
  • 1973
  • 1972
  • 1971
  • 1970
  • 1969

Conditions - Confirmation / Acknowledgement

• I confirm that I have obtained and read a copy of the OSCA Candidate Handbook and understand my rights and obligations. That I have been provided with adequate information about the course which I am enrolling into, to enable me to make an informed decision. I agree to conduct myself in a professional manner and show respect for the RTO staff. I have advised the RTO of any issues (i.e. medical) that could affect my ability to complete the course in which I am enrolling into. I understand that OSCA trainers are authorised to exclude me or other individuals they feel are inappropriate or under the influence of recreational substances.

• I acknowledge I will no longer be eligible for a government subsidised course under the Certificate 3 Guarantee program, as I have a one time only access to this subsidy. I have read and understood the Certificate 3 Guarantee program conditions provided by Occupational Skills Centre Australia.

• Student name and signature:

  Sign

Disclaimer

• Note: OSCA reserves the right to cease delivery in particular qualifications at any time. Where this occurs, students who have yet to complete, will be formally notified of alternative arrangements, including transfer to another qualification within OSCA or to another RTO.

STAFF DECLARATION (Trainer to complete)

• I certify that in relation to the applicant, that I have sighted the following document/s or certified copies of the document/s to determine their residency status:

  Select Australian Birth Certificate Old. Driver's Licence Heavy Vehicle or Marine Licence Dept of Veterans' Affairs/Pensioner Concession Card Health Care Card Commonwealth Seniors Health Card

  • Australian Birth Certificate
  • Old. Driver's Licence
  • Heavy Vehicle or Marine Licence
  • Dept of Veterans' Affairs/Pensioner Concession Card
  • Health Care Card
  • Commonwealth Seniors Health Card

• I certify that in relation to the applicant, that I have sighted the following document/s or certified copies of the document's to determine Australian Citizenship:

  Select Birth Certificate or Birth extract Australian Passport Medicare Card (Green only)

  • Birth Certificate or Birth extract
  • Australian Passport
  • Medicare Card (Green only)

• I have made the student aware of the possible consequences arising from false, misleading or incomplete information:

  Yes

  No

  N/A

• I have checked the enrollment form for completeness:

  Yes

  No

  N/A

• I have approved the enrolment of the student in the course/s being authorized by the Authorised Enrolling Officer's Declaration:

  Yes

  No

  N/A

• Trainer/Assessor's Signature:

  Sign

OSCA Authorised Officer

• Authorising Officer, Position

  Sign