Student enrolment form – The First Aid Training Company – E Firstaid Pty Ltd RTO 91232

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Student Enrolment Form

Course *

Course Date *

Have you any Learning, Literacy or Numeracy issues? *

Yes - Please speak to your trainer
No

If yes, please specify

USI number

Must be 10 characters long. To create or locate your USI, please head to http://www.usi.gov.au

Full Legal Name *

First

Middle

Last

Date of Birth *

Phone

Mobile

Email *

Gender *

Male
Female
Other

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Postal Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Leave blank if same as above

Town of birth *

Of the following, which BEST describes your current employment status? *

Part time
Full time
Self-employed (not employing others)
Self-employed (employing others)
Not employed (not seeking employment)
Unemployed (seeking full-time work)
Unemployed (seeking part-time work)
Employed (unpaid worker in family business)

Are you still enrolled in secondary or senior education? *

Yes
No

What is your highest completed school level? *

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 *

Australia
Other (please specify)

If yes please specify

Have you successfully completed any qualifications? *

Yes
No

Please tick ANY applicable

Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
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

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 the company name

I declare that the information I have provided is true and correct *

Yes
No

Signature *

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Contact Us

The First Aid Training Company

PO Box 9 Mayfield NSW 2304

enquiries@efirstaid.com.au
02 4960 8608

“E Firstaid Pty Ltd [RTO ID: 91232]”
© 2023 Hunter Training Group Pty Ltd