Applicant’s photograph Please attach a recent passport size photo which shows a full front view of your head and shoulders. If your photo is larger than indicated, please trim to size. Please sign reverse of photograph before attaching. 2015 VET Teacher Training Primary Industries Application Form 1. APPLICANT DETAILS 6. REASON FOR TRAINING DOB o.
BOSTES Institute N Title First Name Additional classes
Last Name Introduce new course (extend school curriculum)
Replacement (Complete Section 6 below)
Residential address Other reason: ______________________________________ Postcode Home phone Mobile phone List all classes in Primary Industries for 2015 at your school No. of No. of Classes
Classes
students (Year 11)
students (Year 12)
Email (your school email address is required) Note: Training and event information is emailed directly to the teacher. List all teachers trained in Primary Industries (Indicate if Head Teacher) 2. UNIQUE STUDENT IDENTIFIER (USI) NUMBER Do you hold a Unique Student Identifier (USI) number? If no, go to www.usi.gov.au NOW and obtain before submitting this form Entry Pathway: Accreditation to deliver Agriculture – AGR
3. CURRENT POSITION Employment status in the Catholic Education sector: Yes No Relevant AQF qualification Application to ARC based on recent/relevant industry experience Permanent full‐time Permanent part‐time Temporary Above Establishment
Casual 7. FOR REPLACEMENT APPLICANTS ONLY Who is being replaced? 4. TEACHING PROFILE Name of school School code Why is replacement necessary? (eg. extended leave, transfer, etc.) Principal's name Title First name Surname If replacement is the result of a transfer, to which school has the trained teacher transferred? School address 8. APPLICATION FOR ENTRY OR EXEMPTION School phone School fax Diocesan VET Advisor Diocese Only complete this section if seeking entry into the training program from outside the entry requirements OR exemption from components of the training program (please tick appropriate box/es AND provide relevant evidence). See Tab A for specific requirements. ENTRY into training via ARC application 5. SUBJECT INFORMATION AND / OR EXEMPTION from: Information about subject specialisations is required to determine whether a teacher meets the agreed entry requirements (benchmark) for training to deliver a VET course. Please list the subjects you are accredited to teach and also currently teaching. Subject name No. years taught Eg. ECO Economics 8 Chemical training Tractor training Subject code AHC20110 Certificate II in Agriculture AHC20410 Certificate II in Horticulture TAE40110 Certificate IV Training & Assessment NOTE: Exemption from the Methodology Orientation is not available as it is a MANDATORY component of training. CECNSW 2015 VET Teacher Training Primary Industries Application
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9. FUNDING SOURCE FOR TRAINING  Funding Source Signature of Approval
School Principal (please indicate by selecting one box only) Signature of Approval for VET Advisor
Funding Source Diocese or Self (where applicable) 1. Replacement (Semester 1 ONLY) The school supports the training of the applicant. Signature of School Principal
Signature of VET Advisor
2. Allocation (Semester 2 ONLY) The school supports the training of the applicant. Signature of School Principal
Signature of VET Advisor
3a. RTO The RTO agrees to meet the costs associated with training. 3b. RTO The school supports the training of the applicant. Signature of School Principal
Signature of VET Advisor
4. School The School agrees to meet the costs associated with training. Signature of School Principal
Signature of VET Advisor
5a. Self For casuals engaged in temporary positions. The school supports the training of the applicant. 5b. Self
I agree to meet ALL the costs associated with the training Signature of School Principal
Signature of Applicant
Selected funding source must be signed off by all signatories. 10. DECLARATION BY PRINCIPAL  The information on the attached teacher profile is correct.  The school understands the nature and extent of the VET teacher training program and agrees to support and release the teacher to complete the training requirements.  The school is aware of and able to meet the syllabus and resource requirements of this course. Signature of Principal Date Privacy Notice
The information provided by the applicant is being obtained for the purpose of the administration of the 2015 VET Teacher Training Program by Catholic Education Commission NSW. It will be used by Catholic Education Commission NSW for consideration of the applicant’s admission to the Program and ongoing participation in the Program. Other persons and/or agencies that will or may be provided with this information are other education authorities in both the public and private sector. Reasons for the collection and disclosure of information are for the purposes of consideration of the applicant’s application to participate in the Program, the applicant’s participation in the Program and other purposes relevant to the proper and prudent management of Catholic Education Commission NSW VET Teaching Training Program. The information is provided as part of the applicant’s applying voluntarily to participate in VET Teacher Training. This information may be shared with other RTOs should you change employer. The information will be stored securely. The applicant may correct any personal information provided at any time by contacting your RTO Manager. I understand that if offered a position in the 2015 VET Teacher Training Program, I will be obliged to sign an ACCEPTANCE OF VET TEACHER TRAINING, stating that I:  have read the relevant VET Teacher Training information concerning the training program for the Primary Industries industry curriculum framework,  am aware that unless otherwise advised, I will be required to attend all components of the training program, and  understand that training may be held at venues which may require travel. In some circumstances, overnight accommodation may be required. All costs associated with participation in the training program will be met from the funding source outlined above. I am aware that all components of this training program will need to be completed within SIX MONTHS of commencing training. Failure to complete training within this timeframe may result in the withdrawal from training, incurring additional costs to my school or region, and could jeopardise student accreditation. VET Teacher Training will only pay the original enrolment fee for the training provider. Teachers who do not meet the training provider’s deadlines will be responsible for any re‐
enrolment fees. I certify that the information I have provided on this form is accurate and complete. In applying, I acknowledge that personal information about me will be provided to Catholic Education Commission NSW (CECNSW) and that in the interest of proper and prudent management of its training program, CECNSW may liaise with and share information about me with other education authorities in both the public and private sectors. Statement of understanding: I have:  Completed all sections of this application form.  Attached copies of supporting evidence 11. DECLARATION BY APPLICANT Signature of Applicant Date CECNSW 2015 VET Teacher Training Primary Industries Application
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TAB A APPLICATION FOR ENTRY AND/OR EXEMPTION Acceptable forms of evidence for exemption from component/s of the Primary Industries VET Teacher Training Program are detailed below. ENTRY into training from outside entry requirements 
Acceptable evidence is a certified copy of a letter on company letterhead with role statement and period of service. This letter must be current (within the last 5 years) and/or 
provide a certified copy of the certificate and transcript for a relevant qualification from the following areas; agriculture, horticulture, production horticulture, conservation and land management. Exemption from chemical safety training Provide a certified copy of a current Chemcert or SmartTrain chemical card with the units of competency: AHCCHM201A Apply chemicals under supervision AHCCHM303A Prepare and apply chemicals AHCCHM304A Transport, handle and store chemicals Exemption from tractor safety training Provide a certified copy of a current statement of attainment for or transcript including: AHCMOM202A Operate tractors Exemption from Industry Specific Training Provide a certified copy of the certificate and transcript for: AHC20110 Certificate II in Agriculture with the following units of competency: AHCOHS201A Participate in OH&S processes AHCWRK209A Participate in environmentally sustainable work practices AHCCHM201A Apply chemicals under supervision AHCCHM303A Prepare and apply chemicals AHCCHM304A Transport, handle and store chemicals AHCLSK204A Carry out regular livestock observation AHCLSK206A Identify and mark livestock AHCLSK205A Handle livestock using basic techniques AHCLSK202A Care for health and welfare of livestock AHCLSK211A Provide feed for livestock AHCLSK209A Monitor water supplies AHCINF201A Carry out basic electric fencing AHCINF202A Install, maintain & repair fencing AHCMOM202A Operate tractors AHCMOM304A Operate machinery & equipment AHCWRK204A Work effectively in the industry AHCWRK205A Participate in workplace communications AHCPMG201A Treat weeds AHCWRK201A Observe and report on weather and/or AHC2020410 Certificate II in Horticulture with the following units of competency: AHCOHS201A Participate in OH&S processes AHCWRK209A Participate in environmentally sustainable work practices AHCPCM201A Recognise plants AHCNSY201A Pot up plants AHCNSY202A Tend nursery plants AHCNSY203A Undertake propagation activities AHCPMG201A Treat weeds AHCSOL201A Determine basic properties of soil AHCPMG202A Treat plant pests, diseases and disorders AHCCHM201A Apply chemicals under supervision AHCCHM303A Prepare and apply chemicals AHCCHM304A Transport, handle & store chemicals AHCWRK201A Observe and report on weather AHCWRK204A Work effectively in the industry AHCWRK205A Participate in workplace communications AHCMOM202A Operate tractors AHCMOM203A Operate basic machinery and equipment or A certified copy of a relevant qualification e.g. agriculture or horticulture with documented evidence of industry currency (within the past 5 years). Exemption from Certificate IV Training & Assessment Provide a certified copy of the certificate and transcript for TAE40110 Certificate IV in Training and Assessment if seeking exemption. If you hold TAA40110 Certificate IV in Training and Assessment, please provide a certified copy of the certificate and transcript to enable participation in a program to update your qualification. ** Copies of original documents can be certified by a Justice of the Peace with official stamp OR by School Principal with school stamp. ** CECNSW 2015 VET Teacher Training Primary Industries Application
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