Height Safety Engineers Course Enrollment Form (Personal Details)
Fill out this form prior to attending your course. All fields with a red star are required and must be completed.
Q1. First Name: *
Enter Your First Name
Your answer
Q2. Family Name (Surname) *
Enter your Surname
Your answer
Q3. Given Names
Enter given names
Your answer
Q4. Gender *
Q5. Date of Birth *
MM
/
DD
/
YYYY
Q6. Mobile Phone Number *
Your answer
Q7. Email Address *
Your answer
Q8. Preferred Contact Method *
So we can contact you if we have any issues delivering your course results/documentation
Q9. Name of Emergency Contact *
In case of Emergency who should we contact on your behalf?
Your answer
Q10. Contact Number for Emergency Contact *
Your answer
Q11. House/Unit Number and Street Name *
Enter your dwelling number and street name here
Your answer
Q12. Suburb *
Your answer
Q13. State or Territory *
Q14. Post Code *
Your answer
Q15. USI (Unique Student Identifier) *
Students MUST have a USI. Sign up here if you do not have one ( https://www.usi.gov.au/students/create-your-usi )
Your answer
Q16. What is your highest COMPLETED level of schooling? *
Q17. In which year did you complete your highest level of schooling ? *
Your answer
Q18. Are you still attending School? *
Q19. Are you of Aboriginal and/or Torres Strait Islander Origin ? *
Q20. In which country were you born? *
Q21. Do you speak a language other then English in the home? *
Q22. If you Answered "Yes" to Q21 above please specify Which language (other then English) is spoken most often
Your answer
Q23. How well do you speak English ? *
Q24. Of the following, which best describes your current employment status ? *
Q25. Do you consider yourself to have a disability, impairment or long-term condition? *
Q26. If Yes, please indicate the areas of disability, impairment or long term condition. (This information will remain strictly confidential)
Q27. Have you SUCCESSFULLY completed and of the following qualifications? *
(tick any that apply)
Required
Q28. Of the following, which best describes your main reason for undertaking this course? *
Q29. Course Name *
Please fill out the name of the Course you will be attending
Q30. Course Code *
Enter the course code
Q31. Course Date *
What day do you expect to be attending training ?
MM
/
DD
/
YYYY
Q32. Employer's Name *
Your answer
Q33. Employer's Street Address *
(Number & Street Name)
Your answer
Q34. Employer's Suburb & State *
Your answer
Q35. Employer's Telephone Number *
Your answer
Q36. Landline Phone Number
Your answer
Acknowledgement *
Required
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