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Personal Details
Title
First Name
Middle Name
Last Name
Date of Birth
Gender
Country of Birth
Unique Student Identifier
USI Number
USI Exemption
Address Details
Building Property Number
Unit/Flat Number
Address Lookup
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Street Name
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Postal Building or Property Number
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Postal Street Name
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Education Details
What is your highest COMPLETED school level?
Are you currently at school?
What is your CURRENT school level?
Have you completed any other qualifications?
Select all that apply Bachelor degree or higher degree level
Advanced diploma or associate degree level
Diploma level
Certificate IV
Certificate III
Certificate II
Certificate I
Miscellaneous education
Which best describes your reason for this study?
Demography Details
Which best describes your employment status?
Are you an Aboriginal or Torres Strait Islander?
Main language spoken at home
Needs Details
Do you have a disability or impairment?
Select all the apply Hearing/deaf
Physical
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Acquired brain impairment
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Not Specified
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Please Specify
Declarations

Participation in Training Activities and Practical Exercises

Some training activities and practical exercises conducted by Haz-Ed Services are potentially hazardous. You should ensure that you understand the risks relating to, or arising from, your participation in such activities or practical exercises.

You may choose not to participate in a given activity. However, you must understand that in making such a decision you may fail to satisfy necessary competency assessments for certification.

Injury

In the event that you are injured (no matter how slight) during a practical exercise, the Senior Instructor may remove you from further training until appropriate medical assistance (and clearance if required) is obtained.

Medical Statement

I acknowledge that the course in which I am attending involves practical exercises that will place physical and psychological stress above and beyond that in which I am normally exposed to. I do not suffer from any condition, physical or mental which may adversely affect me during this course. I further acknowledge that by admitting me to this course, Haz-Ed Services, after taking all due care to conduct the course in a safe and professional manner, take no responsibility as to my health or mental status and relies on my statement above.

Enrolling student

The Australian Skills and Qualifications Authority is entitled to collect the information on this form for use by the Commonwealth Department of Education and Training. This information is collected for the purpose of auditing participation and the monitoring and reporting of training outcomes. The information you provide may be accessed by officers of these two departments and by the National Centre for Vocational Education Research (NCVER) for the above purposes.

By accepting this form, I certify that the information provided is true and correct. I further certify that I have been provided sufficient information about my rights and obligations to make an informed decision about enrolment and I agree to the services being provided.

I consent to Haz-Ed Services providing my employer with training results from the above mentioned course.

I consent to being photographed by Haz-Ed Services for training & advertising purposes.

I consent to Haz-Ed Services creating/verifying my USI information via www.usi.gov.au

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