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Course
*
HLTAID009 Provide cardiopulmonary resuscitation
HLTAID011 Provide First Aid
HLTAID012 Provide First Aid in an education and care setting
HLTAID013 Provide First Aid in remote or isolated site
HLTAID014 Provide advanced first aid
HLTAID015 Provide advanced resuscitaiton and oxygen therapy
HLTAID016 Manage first aid services and resources
UETTDRRF004 Perform rescue from a live LV panel
CPPFES2005 Demonstrate first attack firefighting equipment
PUAEME008 Provide Pain Management
Course Date
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Have you any Learning, Literacy or Numeracy issues?
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USI number
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Must be 10 characters long. To create or locate your USI, please head to
http://www.usi.gov.au
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State / Province / Region
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Albania
Algeria
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Andorra
Angola
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Antarctica
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Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
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Ã…land Islands
Country
Leave blank if same as above
Town of birth
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Of the following, which BEST describes your current employment status?
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Self-employed (employing others)
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Unemployed (seeking full-time work)
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Employed (unpaid worker in family business)
Are you still enrolled in secondary or senior education?
*
Yes
No
What is your highest completed school level?
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Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent
Year 8 or below
Never attended school
Country of Birth
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Australia
Other (please specify)
If yes please specify
Have you successfully completed any qualifications?
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Yes
No
Please tick ANY applicable
Bachelor Degree or Higher Degree
Advanced Diplome or Associate Deree
Diploma
Certificate IV (or advanced certificate/technition)
Certificate III (or trade certificate)
Certificate II
Certificate I
Other Education (including certificates or overseas qualifications not listed above)
Of the following, which best describes the main reason you are undertaking this course?
*
To get a job
To develop my existing business
To start my own business
I wanted extra skills for my job
To try for a different career
To get a better job or promotion
It was a requirement for my job
For personal interest/ Self development
To get into another course of study
To get skills for community/volunteer work
Other reasons
Are you of Aboriginal and/or Torres Straight Islander descent?
*
Neither
Aboriginal
Torres Strait Islander
Please select all that apply
Do you speak a language other than English at home?
*
No - English only
Yes - Please specify
Third Choice
If other please specify
Do you consider yourself to have a disability, impairment, or long-term condition?
*
Yes
No
If you have indicated the presence of disability, impairment, or long-term condition, please select from the following:
Hearing/Deaf
Physical
Intellectual
Learning
Mental Illness
Acquired brain impairment
Vision
Medical Condition
Other
Do you give E Firstaid Pty Ltd permission to search for your USI (if required)?
Yes
No
Do you give E Firstaid Pty Ltd permission to create a USI for you (if required)?
Yes
No
Do you give E Firstaid Pty Ltd permission to send a copy of your certificate to your employer (if required)?
Yes
No
If yes, please let us know employers name
I declare that the information i have provided is true and correct
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