Enrolment Form : 3D Safety Services

Student Details

Name*

Title Given Name Middle Name Surname

Date of Birth*

Organisation

Position

Work Phone

Mobile phone

Home phone

Email Address*

Enter preferred contact email, call us if you don't have email.

Residential Address*

Street Address Suburb State Postcode

Postal Address*

Same as previous

Street Address Suburb State Postcode

Gender

Country of Birth

City of Birth*

Are you of Aboriginal or Torres Strait Islander origin?

For persons of both origin, mark both boxes

No
Aboriginal
Torres Strait Islander

Employment

Of the following categories, which BEST describes your current employment?

Languages

Do you speak a language other than English at home? (If more than one language, indicate the one that is spoken most often)

No
Yes

Other Language*

How well do you speak English?*

Schooling

Are you still enrolled in secondary or senior secondary education?

Yes
No

What is your highest COMPLETED school level?

In which year did you complete that school level?

Disability / Assistance

Do you consider yourself to have a disability, impairment or long-term condition?

No
Yes

If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:

You may indicate more than one area
Please refer to the Disability supplement that is available on request from your trainer/assessor if you are unsure.

Hearing/Deaf
Physical
Acquired brain impairment
Vision
Intellectual
Medical condition
Mental illness
Learning
Other

Please list and advise trainer/assessor at the commencement of your course

If you answered YES to the above question do you require any assistance to participate in this course?

If Yes, Please notify your trainer/assessor before commencement of your course

No
Yes

Previous Qualifications Achieved

Have you SUCCESSFULLY completed any of the qualification listed below?

Qualifications Achieved*

Study Reason

of the following categories, which BEST describes your main reason for undertaking this course

Unique Student Identifier

From 1 January 2015, 3D Safety Services can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI. If you do not know your USI you can find it at https://www.usi.gov.au/faqs/find-your-usi.

Enter your Unique Student Identifier (USI) number

In providing my USI, I confirm 3D Safety Services is authorised to collect, use and disclose my student identifier for the purposes required under the Student Identifiers Act 2014.

In providing my USI, I confirm 3D Safety Services is authorised to collect, use and disclose my student identifier for the purposes required under the Student Identifiers Act 2014.

Emergency Contact

Given Name Surname

Relationship to you

Emergency contact number

How did you hear about the course?

Privacy Notice, Covid-19 & Application Declaration

Terms and Conditions*

I have read and agree to the 3D Safety Privacy Notice.*

Covid 19 Protocols

In accordance with the current NSW Government guidelines, until further notice, all students (16 years and over) attending courses at our Cameron Park Training Facility must be fully vaccinated against COVID-19. Students will be required to email their proof of COVID-19 vaccination to 3D Safety. For further enquiries about this, please call 1300 663 195.

On the day of the course you will be required to fill in our Health Screening Form. Please ensure on the day of the course you comply with the following:

* You do not have any symptoms associated with COVID-19 (e.g. fever, cough, sore throat, shortness of breath, sneezing/runny nose or loss of sense of smell)

* You do not have COVID-19 nor are you awaiting the results from being tested for COVID-19

* You or a member of your household have not been in close contact with any known or suspected cases of COVID-19 in the past 7 days

I understand the Covid-19 Protocols required to attend training

Marketing Use Consent

I give 3D Safety Services permission to use photos in public material and social media (including any photos where I may be recognised) as may be useful.

I authorise images of my participation in training to be used by 3D Safety Services for future marketing and business purposes.

I understand that I retain the right to withdraw my consent at any time.

I choose to opt-out of this marketing and usage consent.

Applicant Declaration and Consent*

I declare that the information I have provided to the best of my knowledge is true and correct.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

In making this application for enrolment, I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by3D Safety Services.

I have read and I consent to the collection, use and disclosure of my personal information (which may include sensitive information) pursuant to the information detailed, and NCVER policies, procedures and protocols published on NCVER’s website at www.ncver.edu.au

I hereby consent to 3D Safety Services Pty Ltd providing my employer with result information, and to provide my employer with copies of certificates and/or statements of attainment (if requested).

I have read and understand all of the above information.

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Enrolment Form

Student Details

Privacy Notice, Covid-19 & Application Declaration

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