RTO Course Enrolment Form – 5th Point Australia

Candidate Personal Details
Surname or Family Name*
First Given Name*
Middle Name
Date of Birth*

Day
Month
Year
Gender*
- Male
- Female
- Other
- Email*
- Alternate Email Address*
- Phone (no spaces)*
- D/Licence or PP*
Residential Address*
Street Address Suburb State / Province / Region ZIP / Postal Code Country
Postal Address (if different from above)
Street Address Suburb State / Province / Region ZIP / Postal Code Country
How did you hear about us?*
- 5th Point Website
- Search Engine
- Facebook
- Instagram
Emergency Contact Details
Emergency Contact Name*
- Emergency Contact Phone (no spaces)*
- Emergency Contact Relationship*
Course Information
USI Number (use capital letters)*
Courses*
- RIIWHS204E Work Safely at Heights
- RIIWHS202E Enter and Work in Confined Spaces
- Provide First Aid for Rope Access (HLTAID011)
- Height Safety Systems Inspection and Certification
Study Reasons
Of the following options, which BEST describes your reason for undertaking this course? (Tick ONE box only)
Study Reasons*
- 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
- Personal interest/self development
- To get skills for community/voluntary work
- Other reasons
Employment Details
From the following categories, which best describes your current employment status? (Please tick)
Employment Details*
- Full time employee
- Part time employee
- Self employed (not employing others)
- Employer
- Employed (unpaid worker in family business)
- Unemployed (seeking full time work)
- Unemployed (seeking part time work)
- Unemployed (not seeking work)
Cultural Background
Do you speak a language other than English at home?*
- Yes
- No
If yes, please specify.
How well do you speak English?*
- Very Well
- Well
- Not Well
- Not at all
Do you require language, literacy or numeracy assistance?*
- Yes
- No
Country of Birth*
City of Birth*
Are you of Aboriginal or Torres Straight Islander descent?*
- Neither
- Torres Straight Islander
- Aboriginal
Education
What is your highest completed level of school?*
- Year 12
- Year 11
- Year 10
- Year 9
- Year 8 (or below)
- Never attended school
What year did you complete that school level?*
Are you still attending school?*
- Yes
- No
Since leaving school, have you completed any of the following qualifications?
- Bachelor degree or higher degree
- Advanced diploma or associate degree
- Diploma (or associate diploma)
- Cert. IV (or advanced certificate / technician)
- Cert. III (or trade certificate)
- Cert. II
- Cert. I
- Other Certificate
Disability
Do you consider yourself to have a disability, impairment or long-term condition?*
- Yes
- No
If yes, please tick:
- Vision / Blindness
- Mental Illness
- Learning
- Hearing / Deafness
- Acquired Brain Impairment
- Medical Condition
- Physical
- Intellectual
- Chronic Illness
Other (Please specify)
If you require assistance for a disability, please give details:
Consent*
- I consent to 5th Point taking photos and/or video recordings during my training course. I understand that these photos may be used for promotional purposes, including being published on the website and/or social media.
- I DO NOT consent to 5th Point taking photos and/or video recordings during my training course. I understand that these photos may be used for promotional purposes, including being published on the website and/or social media.
Agree to terms & conditions*
- I have read and agree to the RTO training terms and conditions.
Signed
Dated
MM slash DD slash YYYY

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Candidate Personal Details

Emergency Contact Details

Course Information

Study Reasons

Employment Details

Cultural Background

Education

Disability

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