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)
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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