National Certificate in Beauty Services
(Beautician, Electrology, Cosmetology or Body Therapy)
Qualification by Experience
Qualification by Experience at a glance
You will
HITO will
Complete this application and send it
to HITO with the fee and supporting
information
Evaluate your application and notify you
of your next steps
Complete any workbook and any additional requirements e.g. first aid
and health and safety
Evaluate generic material, register credits
and set up an interview
Meet with an industry assessor to discuss
knowledge or demonstrate practical skills
Send a letter confirming the outcome of
the interview
Follow the steps outlined to complete the
qualification
Issue the National Certificate when all
units are completed and paid for
Trainee details
First names
Previous Last Name/s
Current Last Name
Permanent Address
Post Code
Cellphone
Home Phone
E-mail Address
/
Date of Birth
/
Gender
Male
Female
Ethnic Group (select
any two that apply)
Maori
Pasifika
Is English your second language?
What is your employment status
Yes
NZQA Number
(NSI or NSN)
NZ Residential Status
NZ Pakeha
No
Employer
European
Citizen
Permanent Resident
Other
Do you have a disability that will affect learning?
Yes
No
Employee
Support person details
Name
Relation to the trainee
Contact number
Yes
I authorise this person to discuss my qualification with HITO on my behalf
No
Business details
Business owner
Business Name
Business Address
Post Code
Business Phone
Cellphone
E-mail Address
If you are an employee, you must have a signed employment agreement. Do you have one?
Yes
No
version 5 February 2015
National Certificate in Beauty Services
(Beautician, Electrology, Cosmetology or Body Therapy)
Qualification by Experience Fees
Application Fee
$200
You must pay this fee before we can process your application
NZQA Credit Fees
$2 per credit (there are up to 147 credits within the qualification)
Interview and/or practical session
$65
per hour + any travel and accommodation incurred by the assessor
Payments
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You must pay all your fees.
You may pay by by direct credit at WESTPAC BANK 03-0502-0096479-00 or by cheque (payable to HITO).
To pay by credit card (we don’t accept American Express) please call Accounts on (04) 499 1180.
If paying by direct credit please make the reference for the transaction your cellphone number or your NSI number.
HITO reserves the right to adjust these fees during the course of the training agreement.
HITO fees are not refundable.
If your employment status changes, please let us know as this may affect your fees.
You can pay your credit fees gradually.
Payment method
Cheque
Direct Credit
Credit card
Document Checklist & ID Proofs
Please ensure that where possible you include the following documentation or explain in writing why it is not possible to provide some of
all of it. The government also require that HITO has a copy of documents that prove your identity. Please tick which documents you have
enclosed.
ESSENTIAL Copies of qualifications or units achieved/apprenticeship papers
ESSENTIAL Copy of course content for overseas candidates
ESSENTIAL Course or seminar certificates
ESSENTIAL References
ESSENTIAL Summary of work history details (including a CV)
ESSENTIAL Copy of your NZ Birth Certificate or passport (certified by your employer or HITO SLM)
ESSENTIAL Confirmation of NZ Residency/Citizenship
Legal Declaration and Signatures - You must sign this document
I acknowledge that I have read and understood the provisions of this Agreement. I confirm that I have provided the necessary
documentation confirming my eligibility to undertake training in New Zealand and that the information provided is true and accurate.
Trainee Signature
/
/
Employer Signature
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/
HITO SLM Signature
/
/
version 5 February 2015
National Certificate in Beauty Services
(Beautician, Electrology, Cosmetology or Body Therapy)
Qualification by Experience Pg 2
Experience
Time served in industry
Unit Standards Completed
Any other qualifications
Reason for your application
Work History Details
Employment history in nail technology or other relevant positions
Date e.g.) 1985-1989
Employer / Business Name
Role and responsibilities of employment
version 5 February 2015
National Certificate in Beauty Services
(Beautician, Electrology, Cosmetology or Body Therapy)
Qualification by Experience Pg 3
Qualifications
You only need to complete this is you have a full or part international qualification. If you have printed material that outlines details of this
qualification, you can attach that to this application too. Please attach copies.
Qualification Name
Length of
course
Date achieved
Awarded by
Country
List of course content
Courses & Seminars Attended
Please list all courses/seminars you have attended in the last 5 years. Please include copies of certificates
Select your qualification
Please tick the QbyE qualification that you would like to participate in. You can enter more than one.
Cosmetology (Level 3)
Beautician Work
Experience
Beautician (Level 4)
Electrotherapy (Level 5)
Body Therapy (Level 5)
Please tick the approximate number of times you have given the following services in the last two years.
Never
1-5 times
6-20 times
more often
Facials
In depth skin analysis
Electrical facial therapy
Waxing – hot wax
Waxing – soft wax
Eye lash/brow tint & brow shape
Make up – special occasion
Manicures
Pedicures
version 5 February 2015
National Certificate in Beauty Services
(Beautician, Electrology, Cosmetology or Body Therapy)
Qualification by Experience Pg 4
Body
Therapy
Work
Experience
Please tick the approximate number of times you have given the following services in the last two years.
Never
1-5 times
6-20 times
more often
Electrology Work
Experience
Please tick the approximate number of times you have given the following services in the last two years.
Never
1-5 times
6-20 times
more often
Swedish body massage
Figure analysis
Electrical body therapy
In depth consultation for electrolysis
Electrolysis – galvanic
Electrolysis – HF
Electrolysis – blend
Cosmetology
Work
Experience
Please tick the approximate number of times you have given the following services in the last two years.
Never
1-5 times
6-20 times
more often
Makeup - special occasion
Manicures
Perdicures
Eyelash/brow tint and eyebrow shaping
Facial cleansing
Cosmetic counter client demonstration
Other Information
Please use this space or attach more paper to note any other information that might be helpful for us when evaluating your application.
A portfolio of your work can also be helpful in assisting the assessor.
Referees
Where possible please provide the contact details for two professional/qualified referees who can confirm your skills and your employment
records. You may also include copies of any other references that will support your application.
Have all the signatures been completed? Please post to your HITO office at either:
UPPER NORTH ISLAND HITO, PO Box 11 921, Ellerslie, Auckland 1542
LOWER NORTH ISLAND HITO, PO Box 11 764, Central Office, Wellington 6142
SOUTH ISLAND HITO, PO Box 1575, Christchurch 8140
version 5 February 2015
Employer and Trainee
Agreement to be a Member of HITO
pg 1
Please complete this section if you want to be a Member of HITO.
You can be a Member in one of the following two membership categories:
a. EMPLOYER MEMBER: An organisation that employs or contracts one or more persons to provide barbering, beauty and/or
hairdressing services, OR a person who is a sole business operator and provides such services (e.g. local hairdressing salon).
or
b. TRAINEE MEMBERS: An individual who has entered into a HITO Training Agreement with HITO and who wishes to be a
member of HITO.
A. Complete this section to become an Employer Member
Please tick the type of membership you are applying for (select one only).
New Membership
I do not wish to receive any of the following information:
Renew Membership
(Please refer to paragraph 6 of the Membership Declaration)
Information and activities relating to HITO.
Information about the products and services of sponsors or funders of HITO.
Membership Declaration : I have read and understand this Membership Agreement and the Membership Declaration (over page)
Signature
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B. Complete this section to become a Trainee Member
Please tick the type of membership you are applying for (select one only).
New Membership
I do not wish to receive any of the following information:
Renew Membership
(Please refer to paragraph 6 of the Membership Declaration)
Information and activities relating to HITO.
Information about the products and services of sponsors or funders of HITO.
Membership Declaration : I have read and understand this Membership Agreement and the Membership Declaration (over page)
Signature
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Consent for under 18 Year Old Applicants (please complete if employer or trainee is under 18 years)
I am the parent / guardian / caregiver of the employer/trainee who is under 18 years of age. I have read and understood the
attached Membership Declaration and I consent to the Membership Agreement of the employer/trainee on the basis set
out in this Membership Agreement and Membership Declaration. I also consent to my name and contact details, as detailed
below, being collected, held, and used, as the parent / guardian / caregiver of the employer/trainee in accordance with the
purposes set out in paragraph 6 of the Membership Declaration, or, for contacting me in case of an emergency involving the
employer/trainee.
Parent
Guardian
Caregiver
Other (please specify)
First Name
Last Name
Home Address
Post Code
Home Phone
Cellphone
Email Address
Signature
ALL PRICES INCLUDE GST
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DOCUMENT REF : Version 1 Training Agreement Membership Form
Employer & Trainee
Membership Declaration
pg 2
1. DECLARATION
I declare that I have authority to complete and sign this Membership Agreement and that all information supplied in this Membership
Agreement is true and correct. If any of this information changes, I acknowledge that I will notify HITO of the changes, in writing, as soon as
possible after they occur. If any of the information I have provided is not true or is misleading, I acknowledge that my membership may be
terminated at the discretion of HITO.
2. TERMINATION
I understand:
a. I may resign from my membership in accordance with the HITO Constitution.
b. HITO may terminate my membership in accordance with the HITO Constitution.
c. If my HITO Training Agreement is terminated by HITO my membership also terminates.
d. If I am a Trainee Member and my HITO Training Agreement is terminated by my employer my membership also terminates.
e. If I am an Employer Member and I terminate my HITO Training Agreement my membership does not terminate but if I no
longer have any trainees I may have to pay a membership fee to HITO.
3. BOUND BY RULES
I will be bound by the HITO Constitution, Regulations, policies, manuals, and reasonable directions of HITO.
4. NO LIABILITY
I will not hold HITO, or its respective officers or employees, responsible for any claims, losses, expenses and costs (including legal costs)
which may arise from or in connection with, my membership except in the case of gross negligence or a wilful act or omission on the part
of HITO.
5. INDEMNITY
I indemnify HITO, and its respective officers or employees, from all claims, losses and expenses (including legal costs) suffered or incurred
at any time as a result of, or resulting directly or indirectly from, my failure to observe the HITO Constitution, Regulations, policies, manuals,
guidelines and reasonable directions of HITO.
6.PRIVACY
I agree that HITO, and its respective officers or employees, can collect, hold, use and disclose my personal information as provided in this
Membership Agreement (and any updated or additional personal information HITO obtains from me whilst a Member, including any photo
or other record of my image) for the purposes of:
a. processing my application for membership including notifying HITO of the information on this form so HITO can compile
a register of members, compile a national database of members (accessible only in accordance with the Constitution and
Regulations of HITO), and request me to renew if my membership lapses;
b. including my photograph or other imagery on the HITO website, in newsletters, annual reports, or similar official publications;
c. if I agree (by not ticking the appropriate box in this Membership Agreement), providing me with information and activities
relating to HITO;
d. if I agree, (by not ticking the appropriate box in this Membership Agreement), enabling HITO to contact me with information
about the products and services of sponsors or funders of HITO;
e. enabling HITO to comply with any statute, regulation, by-law or other regulatory instrument that requires collection or
disclosure of personal information;
f. retaining the information provided on this form (as an inactive member) if my membership lapses for a maximum period of 3
years for the above purposes; and
g. any other purpose I agree to in writing.
7. USE, SECURITY & ACCESS
I understand that my personal information will only be used for the purposes listed in paragraph 6 above and in accordance with the HITO
Constitution and Regulations, and that, in accordance with the Privacy Act 1993:
a. my personal information will be held securely;
b. I will have access to my personal information; and
c. my personal information will be corrected upon request.
8.CONTINUED MEMBERSHIP
I understand that upon payment of my membership fee(s) (if any), if I am accepted to membership, I will become a member of HITO and
that by paying such fee(s) and renewing this Membership Agreement by the due date(s), I will continue to be a member of HITO for the
duration of my membership as specified in accordance with the Constitution, unless I resign or my membership is terminated.
9.INTERPRETATION
Every reference to “I” and “my” in this document includes the applicant and the parent/guardian/caregiver of the applicant (if applicable). All
definitions in this document have the same meaning as set out in the HITO Constitution.
A copy of the HITO Constitution is available on the HITO website www.hito.org.nz/members
For additional information please contact: HITO Members, PO Box 11764 Wellington 6011, New Zealand
Ph: 04 499 1180 Fx: 04 499 3950 Em: members@hito.org.nz
ALL PRICES INCLUDE GST
DOCUMENT REF : Version 1 Training Agreement Membership Form