Course Name: ………………………………………
Course Date:………………
Return form to: info@metraining.edu.au
1. PARTICIPANT DETAILS
Title:
(Please print clearly in BLOCK LETTERS)
☐
Mr/Mrs/Miss/Ms
☐
Male
First name:
Family name:
Phone:
Mobile:
Email:
*USI number:
Postal Address:
Female
Date of Birth:
Postcode:
State:
Electrical licence details (include a copy of your licence with your application)
☐ Mechanic ☐ Fitter ☐ Mechanic/fitter ☐ Apprentice Licence number: ______________________
Expiry date:__________________________
☐ Other electrical/cabling licence (ie restricted/ACMA)
Licence number: ______________________
Expiry date:__________________________
Language and cultural diversity
Country of birth ☐ Australia
☐ Other, please specify ___________________________________
Are you of Aboriginal or Torres Strait Islander origin?
☐ No ☐ Yes, Aboriginal ☐ Yes, Torres Strait Islander ☐ Both Aboriginal and Torres Strait Islander
Do you speak a language other than English at home? ☐ English only ☐ If yes, please specify:
________________________
Schooling
What is your highest completed school level?
☐
Year 12 or equivalent
☐
Year 9 or equivalent
☐
Year 11 or equivalent
☐
Year 8 or equivalent
☐
Year 10 or equivalent
☐
Never attended school
What year did you complete that level? _____________
Previous Qualifications
Have you successfully completed any of the following qualifications? ☐ Yes ☐ No
☐ Bachelor degree or higher degree
☐ Certificate IV
☐ Advanced diploma or associate degree ☐ Certificate III (or trade cert)
☐ Diploma (or associate diploma)
☐ Certificate I
☐ Other
☐ Certificate II
Page 1 of 4
1. PARTICIPANT DETAILS
(Please print clearly in BLOCK LETTERS)
(cont)
Disability
Do you consider yourself to have a disability, impairment or long-term condition? ☐ Yes ☐ No
If yes, then please indicate the area of disability, impairment or long term condition:
☐ Hearing/deaf
☐ Physical
☐ Intellectual
☐ Medical Condition
☐ Mental illness
☐ Acquired brain impairment
Study reasons
Of the following categories, which best describes your main reason for undertaking this training?
☐ To get 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
☐ To get into another course of study ☐ For personal interest or self-development
☐ Other reasons
2. CITIZENSHIP / VISA HOLDER STATUS
In order to satisfy eligibility requirements for Construction Skills Queensland (CSQ) funding you must meet
citizenship or visa requirements. Please indicate your status.
I declare that I am:
☐
Australian or New Zealand
Citizen
☐
Permanent resident of
Australia
☐
Refugee or humanitarian
visa holder
Please attach a certified copy of ONE of the following documents to your enrolment form:
☐
☐
Birth Certificate
☐
☐
Passport
Visa
Medicare Card (Green only)
3. QUEENSLAND RESIDENCE / QUEENSLAND EMPLOYMENT STATUS
CSQ requires that eligible participants must be either permanently residing in Queensland or permanently
employed in Queensland. Please indicate your status.
I declare that I am:
☐
Permanently residing in Queensland
☐
Permanently employed in Queensland
Please attach a copy of ONE of the following documents to your enrolment form:
☐
Queensland Driver Licence
☐
Telephone account
☐ Bank statement
☐
Real estate agent
statement
☐
Other formal documentation stating full name and current
residential address
Page 2 of 4
4. BUILDING AND CONTRUCTION INDUSTRY EXISTING WORKER STATUS
In order to satisfy CSQ eligibility requirements, you must be an EXISTING WORKER in the Building and
Construction Industry and have at least one month or more employment relationship with your employer. Selfemployed workers are eligible if they can provide evidence of at least one month employment as a ‘worker' in the
industry. Please tick the relevant boxes below.
I declare that I am:
☐
Employed worker in Building and
Construction Industry
☐ Micro Business (0-4FTE)
☐Large Business (200+FTE)
☐
Self-employed worker in Building
and Construction Industry
☐ Small Business (5-19 FTE)
☐ Medium Business (20-199FTE)
I declare that I am not:
☐ An employee of an Authority or RTO
☐
Working in a managerial, clerical,
professional or ancillary capacity
☐
Funded by an Authority for delivery of the
same training being undertaken as part of
this program
☐ A contracted trainer or assessor
☐ Currently enrolled & participating in a
Queensland secondary school program
Please provide evidence of your Building and Construction Industry Existing Worker status by completing either:
5) Employer Verification; or 6) Self-Employed Declaration
(To be completed and signed by
EMPLOYER)
5. EMPLOYER VERIFICATION
Company name:
ABN Number:
Postal address:
Postcode:
I hereby confirm that our organisation is part of the Building and Construction Industry in Queensland and that
(Full name)
(Job title)
is currently employed in QLD as
(Date)
and commenced employment with us on the
Name:
Title:
Signature:
Date:
6. SELF-EMPLOYED DECLARATION (if applicable)
(To be completed by SELF- EMPLOYED participants)
Business name:
ABN Number:
Postal address:
Postcode:
I hereby declare that I am self-employed in Queensland’s Building and Construction Industry. I am currently a
(Job title)
and have been working in this role since
(Year)
I will provide Master Electricians with a copy of any relevant documentation that will support this declaration.
Page 3 of 4
7. PARTICIPANT DECLARATION
(To be signed by PARTICIPANT)
In signing this declaration I confirm that

The information provided and any supporting documentation attached is true and correct to the best of
my knowledge

I have not completed 3 CSQ Short courses during the period between 1 October 2014 and 30
September 2015.
Name:
Signature:
Date:
8. PAYMENT DETAILS
(To be signed by PARTICIPANT)
Participant contribution:
Card number _ _ _ _
_ _ _ _
_ _ _ _
_ _ _ _
Expiry date _ _
/ _ _
☐ Cheque ☐ Visa ☐ Master Card
Name on card: _______________________________________________
Signature: _________________________________________
$ _______________________
Terms and conditions
Full terms and conditions can be viewed in our Student Handbook located at www.masterelectricians.com.au/training or by contacting 1300 889
198.
Privacy: All data collected on this form is confidential and Master Electricians SkillsConnect only collects this information for the purposes of
training and assessment, reporting, administration and evaluation of the program. Master Electricians SkillsConnect will only disclose information o
the contractors or agents of Department of Industry, Innovation, Science, Research and Tertiary Education (DIISRTE), Department of Education
and Training (DET), Innovation and Business Skills Australia (IBSA – Industry Skills Council), E-Oz Energy Skills Australia Industry Skills Council)as
relevant to this program. MEA, DISSRTE , DET or the industry Skills Council may also disclose personal information to another party without
consent where authorised or required by law.
Refund policy: Cancellations received more than 10 working days prior to commencement of course will receive a 50 per cent refund.
Cancellations received less than 10 working days prior to the course commencement will not be eligible for a refund. Enrolments however may be
transferred to another course provided cancellations are received no less than two working days prior to the course commencement. Participants
may be provided with a refund or partial refund of course fees in exceptional circumstances. In the event where a course is cancelled by Master
Electricians SkillsConnect, if the participant cannot be transferred to a suitable alternative course a full refund will be provided. Enrolment will only
occur after payment is received and an acknowledgement will be forwarded to you by email/mail to confirm your enrolment.
☐ I hereby acknowledge and accept the terms and conditions of enrolment and cancellation.
☐ I certify that all information that I have provided is true and correct. I consent to release of my personal information for the purposes outlined
under the Privacy paragraph above.
☐ I consent to allow Construction Skills Queensland to contact me for the purposes of review and survey.
☐ I would like to receive information on becoming a Master Electricians member.
Participant’s signature: _________________________ Date: ________________________________
*USI number: From 1 January 2015, students undertaking nationally recognised training may need to provide their USI to their registered
training provider before they can receive their training records and results. You will continue to use your USI for any future nationally
recognised training you undertake.
Please visit the USI website: www.usi.gov.au – create your USI , and record it in a safe place and write in on the enrolment form.
Page 4 of 4