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RTO No. 70220

Participant Enrolment Form

Certificate IV in Transport and Logistics
(Road Transport – Car Driving Instruction)
TLI41221

Please complete the form.

Date of Application:

DD slash MM slash YYYY

Learner ID (office use only):

Course Title:

Ten Digit Unique Student Identifier (USI):

If you already have a USI, please insert it in the field above, otherwise go to Unique Student Identifier Website and follow the instructions to obtain one. Please note that your enrolment will not be registered unless you include your USI Number.

Personal Details

First Name:

Middle Name:

Family Name:

Date of Birth:

DD slash MM slash YYYY

Town/City of Birth:

Country of Birth:

Email Address:

Gender:

Male

Female

Contact Details

Mobile Phone:

Emergency Contact:

Address:

Suburb:

State & Postcode:

Education Information

Are you currently attending secondary school?

Yes

No

What is/was your highest level completed?

Year 8 or below

Year 9

Year 10

Year 11

Year 12

Did not go to school

In which year did you complete that school level?

Have you successfully completed any post-secondary education?

Yes

No

If yes, select all that apply

Bachelor or higher

Advanced Diploma

Diploma

Certificate IV

Certificate III

Certificate II

Certificate I

Miscellaneous

ONLY if you reside in Victoria, please select all that apply

Australian Qualification

Australian Equivalent

International

Individual Needs

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

Yes

No

Are you of Aboriginal or Torres Strait Islander origin? (Optional)

Yes, Aboriginal

Yes, Torres Strait Islander

Yes, Aboriginal and Torres Strait Islander

No, neither Aboriginal nor Torres Strait Islander

Which BEST describes your current employment status?

Full-time Employee

Part-time Employee

Self-employed (not employing others)

Self-employed (employing others)

Employed (unpaid worker in a family business)

Unemployed (seeking full-time work)

Unemployed (seeking part-time work)

Not employed (not seeking employment)

Do you speak a language other than English at home?

Yes

No

If you answered 'YES' above.

What is your main language?

How well do you speak English?

Very Well

Well

Not Well

Not at all

Do you have any other needs that we should be aware of?

Drivers Licence Number:

Licence Expiry Date:

MM slash DD slash YYYY

What is your reason for completing this course? (Optional)

Get a job

Develop my existing business

Start my own business

Try for a different career

Get a better job or promotion

It was a requirement of my job

I wanted extra skills for my job

Get into another course

For personal interest or self-development

To get skills for community/Voluntary Work

Other reasons

By clicking submit you confirm that you have read our Student Handbook.(Required)

I have read and understood the Student Handbook.

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