Enrolment Form - Key Employment

Office Use Only
Copy sent to
USI Verified
RTO code: 91639
Student Number:
Participant Personal Details
Title: (Mr, Mrs, Miss)
Gender: M/F
USI Number:
Given Names:
Date of Birth:
Town of Birth:
You will be emailed your results after each unit
Country of Birth:
Emergency Contact:
Emergency contact
phone number:
Course Details:
Training Site:
Coffs Harbour
Full Course Name: ________________________________
Course Code: ________________________________________
Course Start Date: ____________________________________
Course End Date: ________________________________
How did you hear about this course? TV
Kempsey (circle)
Employment Consultant: _____________________________
(if applicable)
Education Outcome: Y/N
Classroom/Flexible/1:1 (circle)
 Fee for Service
OTHER __________________________________________________________________________________________________________
Please complete the following questions. This information will be used by Training at Key Employment to further
develop our courses to suit your needs. Statistical information from this form will be provided to stakeholders.
Participant Personal Information:
Citizenship: ______________________________________ Language spoken at home? __________________________________
1. Are you: Aboriginal? Yes/No or Torres Strait Islander? Yes/No
2. Do you have any disabilities including: physical, mental health or learning? Yes/No
3. If yes, please specify: _______________________________________________________________________________________
If yes, do you require any special assistance?
4. Do you require assistance with literacy or numeracy? Yes/No
If yes, our training consultants will discuss a plan to assist you.
LLN Comments:
Version 9 Jan 2016 - Approved by: ME
Training at Key Employment
Enrolment Form
Page 1
5. Do you have a medical condition that may require emergency care? Yes/No
If yes, outline condition and care plan: (our First Aid Officer will discuss the care plan with you)
6. Are you still at school?
Highest level of school completed? ________________________________
7. In which calendar year did you complete school? __________________
8. Since leaving school have you gained any formal qualifications? Yes/No Highest level: _____________________
9. Have you enrolled in any accredited training with Key Employment within the last 24 Months? YES/NO
If yes, which course: ________________________________________________________________________________
10. What is the main reason for your study? _______________________________________________________________
11. Which of the following best describes your employment status:
Unpaid family worker
Self employed
Unemployed – seeking full time work
Full time employee
Unemployed – seeking part time work
Part time employee
Unemployed – not seeking employment
Payment, Refund Policy and USI#
I realise and accept:
That a place on a course cannot be assured unless payment arrangements are in place.
Courses may be cancelled or rescheduled if there are insufficient students attending. A full refund will be given.
Cancellations with more than 5 working days’ notice will be accepted and a full refund given.
No refunds will be made for cancellations with less than 5 working days’ notice.
If no notice is given and a person does not attend the course. The full fee will be charged.
I have received and read Training at Key Employment’s Pre-Enrolment Information, including the refund policy. The policy
of Training at Key Employment is at all times to be fair and equitable to registered students.
Training at Key Employment may accept payment of no more than $1000 from each individual student prior to the commencement of the
course. Following course commencement, the RTO may require payment of additional fees in advance from the student but only such that
at any given time, the total amount required to be paid which is attributable to costs yet to be incurred on behalf of the student for tuition or
other services yet to be delivered to the student does not exceed $1,500. Applications for refunds must be made to the Training Manager. If,
for a good reason, a commenced course is cancelled or discontinued or a student withdraws, a refund proportionate to the period of time
not completed on that course will be refunded. If the course has not commenced and the student is unable to commence, a refund of 90%
of the full fees will be forwarded to the student. 10% will be retained as administration charges.
I agree to abide by the rules of Training at Key Employment that may apply to me. I declare that the submission of incorrect
or incomplete information may result in a cancellation of enrolment.
I recognise that it is my responsibility to provide all necessary documentary evidence in order to show competency has
been achieved.
I recognise that it is my responsibility to provide 100 points of identification.
I understand that no SOA or Certificate will be issues without identification and a USI. If I don’t have a USI that the RTO has
my permission to apply for one on my behalf.
Version 9 Jan 2016 - Approved by: ME
Training at Key Employment
Enrolment Form
Page 2
Travel Concession Card
If you require a Travel Concession Card to attend your course please speak with your Employment Consultant or
Training Administration.
Payment Method
Payment is to accompany your application/enrolment form PRIOR to course commencement.
A tax invoice and receipt will be sent on receipt of payment.
Course Cost: $
 Key Employment will be paying for this course, please internal invoice Key Employment.
Approved by Employment Manager: ____________________________________ Date:___________________________
 I would like to pay by cash, cheque/money order (make payable to Training at Key Employment)
 I would like to pay by EFT.
Account name: Key Training
BSB: 704328
Account Number: 220742 (s11 if it is a BCU account you are transferring from).
Receipt Number:
 I would like my organisation to be invoiced for this course. (Purchase order or letter must accompany this
enrolment form)
 A purchase order is attached.
Photo ID – Proof of Identity
As a client you are required to provide 100 points of identification which is to be attached to your Enrolment Form.
Please complete the 100 point check form (page 4) with the help of Key Employment staff, who will sight the original
Version 9 Jan 2016 - Approved by: ME
Training at Key Employment
Enrolment Form
Page 3
If over 18 years of age at least one photo ID must be produced from Category A.
Original sighted by
Category A
Birth or Citizenship Certificate
(or certified extract)
Driver licence
RMS Photo Card
Category B
Centrelink card
Veteran Affairs Gold Card
Mortgage documents
Reference from current employer or
previous employer within the last 2 years
Utility accounts, rental records
Proof of name change
eg: marriage certificate
Medicare card, seniors card
Bank statement, council rates
Credit and Debit cards
Electoral enrolment card
Insurance renewal
Motor vehicle registration
IF YOU ARE UNDER 18 years of age, you
MUST provide:
Medicare Card (for USI)
Birth or Citizenship Certificate
(or certified extract)
RMS Photo Card
A written statement from a school
official on school letterhead which
includes the student’s full name and
date of birth.
Version 9 Jan 2016 - Approved by: ME
Training at Key Employment
Enrolment Form Page 4