RTO Course Enrolment Form – 5th Point Australia

Candidate Personal Details

Surname or Family Name*

First Given Name*

Middle Name

Date of Birth*

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Gender*

Male
Female
Other

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Residential Address*

Street Address Suburb State / Province / Region ZIP / Postal Code Country

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Postal Address (if different from above)

Street Address Suburb State / Province / Region ZIP / Postal Code Country

How did you hear about us?*

Emergency Contact Details

Emergency Contact Name*

Course Information

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USI Number (use capital letters)*

Courses*

RIIWHS204E Work Safely at Heights
RIIWHS202E Enter and Work in Confined Spaces
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)

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Study Reasons*

Employment Details

From the following categories, which best describes your current employment status? (Please tick)

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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

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Do you speak a language other than English at home?*

Yes
No

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If yes, please specify.

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How well do you speak English?*

Very Well
Well
Not Well
Not at all

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Do you require language, literacy or numeracy assistance?*

Yes
No

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Country of Birth*

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City of Birth*

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Are you of Aboriginal or Torres Straight Islander descent?*

Neither
Torres Straight Islander
Aboriginal

Education

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What is your highest completed level of school?*

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What year did you complete that school level?*

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Are you still attending school?*

Yes
No

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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

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

Yes
No

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If yes, please tick:

Vision / Blindness
Mental Illness
Learning
Hearing / Deafness
Acquired Brain Impairment
Medical Condition
Physical
Intellectual
Chronic Illness

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Other (Please specify)

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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

Cart

Candidate Personal Details

Emergency Contact Details

Course Information

Study Reasons

Employment Details

Cultural Background

Education

Disability

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