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
Q2. Family Name (Surname)
Enter your Surname
Q3. Given Names
Enter given names
Q5. Date of Birth
Q6. Mobile Phone Number
Q7. Email Address
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?
Q10. Contact Number for Emergency Contact
Q11. House/Unit Number and Street Name
Enter your dwelling number and street name here
Q13. State or Territory
Q14. Post Code
Q15. USI (Unique Student Identifier)
Students MUST have a USI. Sign up here if you do not have one (
Q16. What is your highest COMPLETED level of schooling?
Year 12 (or equiv.)
Year 11 (or equiv.)
Year 10 (or equiv.)
Year 9 (or equiv.)
Year 8 or below
Never attended school
Q17. In which year did you complete your highest level of schooling ?
Q18. Are you still attending School?
Q19. Are you of Aboriginal and/or Torres Strait Islander Origin ?
Yes - Aboriginal
Yes - Torres Straight Islander
Yes - Both
Q20. In which country were you born?
Q21. Do you speak a language other then English in the home?
No, English Only
Q22. If you Answered "Yes" to Q21 above please specify Which language (other then English) is spoken most often
Q23. How well do you speak English ?
Not at all
Q24. Of the following, which best describes your current employment status ?
Self-employed (not employing others)
Employed (unpaid worker in family business)
Unemployed (seeking full-time work)
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)
Acquired Brain Impairment
Q27. Have you SUCCESSFULLY completed and of the following qualifications?
(tick any that apply)
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma (or Associate Diploma)
Certificate IV (or Advanced Certificate/Technician)
Certificate III (or Trade Certificate)
Certificate other then the above
None (No previous Qualifications)
Q28. Of the following, which best describes your main reason for undertaking this course?
To get a job
To start my own business
To develop my existing business
To get a better job or promotion
To try for a different career
It was a requirement of my job
I wanted extra skills for my job
To get into another course of study
For personal interest or self-development
Q29. Course Name
Please fill out the name of the Course you will be attending
Work Safely At Heights - RIIWHS204D
Course in Asbestos Awareness - 10314NAT
Working with Asbestos - 10559NAT
Provide First Aid & and Provide CPR - HLTAID003 & HLTAID001
Provide First Aid (only) - HLTAID003
Provide CPR (only) - HLTAID001
Work Safely in the Construction Industry (White Card) - CPCCOHS1001A
Enter & Work in Confined Spaces - RIIWHS202D
Enter & Work in Confined Spaces - Refresher
Q30. Course Code
Enter the course code
HLTAID003 & HLTAID001
Q31. Course Date
What day do you expect to be attending training ?
Q32. Employer's Name
Q33. Employer's Street Address
(Number & Street Name)
Q34. Employer's Suburb & State
Q35. Employer's Telephone Number
Q36. Landline Phone Number
I declare that, to the best of my knowledge, the information I have provided is correct and complete
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service