Chemqual – Chemical training & certification course

Fully Accredited Training

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Course Enrolment

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14%

PAUL JOHN MCMAHON RTO 70207
PARTICIPANTS WILL REQUIRE A VALID UNIQUE STUDENT IDENTIFIER (USI) TO RECEIVE A STATEMENT OF ATTAINMENT

If you don't have USI please get it from USI website
USI*

Personal Details
Enter your full name*
Given Names Surname
Enter your birth date*
Gender*
- Male
- Female
What is the address of your usual residence?*
Street Address Address Line 2 City State Post Code

Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state’s or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.
What is your postal address (if different from above)?
Street Address Address Line 2 City State Post Code

Language and cultural diversity
In which country were you born?*
- Australia
- Other
Please specify*
7. Do you speak a language other than English at home?*
- No, English only
- Yes, other
Please specify*
8. How well do you speak English?*
- Very well
- Well
- Not well
- Not at all
9. Are you of Aboriginal or Torres Strait Islander origin?*
- No
- Yes, Aboriginal
- Yes, Torres Strait Islander
(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)

Disability
10. Do you consider yourself to have a disability, impairment or long-term condition?*
- Yes
- No
11. If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:*
- Hearing/deaf
- Physical
- Intellectual
- Learning
- Mental illness
- Acquired brain impairment
- Vision
- Medical condition
- Other

Schooling
12. 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
13. In which YEAR did you complete that school level?*
14. Are you still attending secondary school?*
- Yes
- No
Previous qualifications achieved
15. Have you SUCCESSFULLY completed any of the following qualifications?*
- Yes
- No
16. If YES, then tick ANY applicable boxes.*
- Bachelor degree or higher degree
- Advanced diploma or associate degree
- Diploma (or associate diploma)
- Certificate IV (or advanced certificate/technician)
- Certificate III (or trade certificate)
- Certificate II
- Certificate I
- Certificates other than the above

Employment
17. Of the following categories, which BEST describes your current employment status?*
- Full-time employee
- Part-time employee
- Self employed - not employing others
- Employer
- Employed – unpaid worker in a family business
- Unemployed – seeking full-time work
- Unemployed – seeking part-time work
- Not employed – not seeking employment
Study Reason
18. Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship?*
- To get a job
- To develop my existing business
- To start my own business
- To try for a different career
- To get a better job or promotion
- It was a requirement of my job
- I wanted extra skills for my job
- To get into another course of study
- For personal interest or self-development
- Other reasons

Conditions of Enrolment
Please read the following, if you have any queries please consult our website or contact us directly for more information.
a) Information that I have provided as part of this enrolment form will be stored and used to issue a Statement of Attainment and associated cards. I understand this information will be kept secure and remain private and confidential except in instances it must be produced in accordance with requests from State or Commonwealth agencies.
b) Any information may be used and stored with my course assessment material. This information may be provided to State or Commonwealth agencies, and includes performance reviews of this RTO (Paul John McMahon 70207).
c) In signing this confirmation I acknowledge that I have been made aware of the requirements above and agree to this information being shared in these instances.
d) I accept full responsibility for any injury to myself, others or for loss or damage to any personal property as a result of participation. I confirm that I am physically and mentally able to undertake the training and assessment activities, or I have made any impairment or special requirement known upon registration.

By ticking the box it indicates that I have been made aware of enrolment and participation policies and conditions, and that I understand my requirements. I also agree to abide by these policies and conditions which are provided at www.chemqual.com.au or by direct contact with staff. I confirm that information provided by me is true and correct, and that assessments completed by me are my own work or in accordance with direction from the RTO.
*
- I accept conditions of enrolment

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ABN: 53 144 960 606

Paul John McMahon RTO 70207

PO BOX 332,
Wickham NSW 2293
Phone: 0447 400 571

PO BOX 60,
Attunga NSW 2345
Phone: 0447 400 571

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