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Title

First Name

Last Name

Date of Birth

Email

Mobile Number

Home Phone

Work Phone

Residential Address

Primary Address

City

State

Post Code

Postal Address

Postal address same as residential address

Primary Address

City

State

Post Code

Which Qualification(s) are you applying for?

Qualification/Program 1

Qualification/Program 2

Qualification availability may change from time to time without notice.

How many years have you been working in this Industry in Australia?

How many years have you been working in this Industry Overseas?

When did you last work in this industry in Australia and for how long were you employed?

What is the name and ABN of your employer? (if self-employed please provide your ABN)

Do you have any formal qualifications either Australian or from overseas related to this industry?YesNo

In what YEAR did you complete this level?

Which qualifications have you completed?NoneCertificate IICertificate IV or Advanced CertificateDiploma or Associate DiplomaAdvanced Diploma or Associate DegreeCertificate ICertificate III or Trade CertificateOther CertificatesBachelor Degree or Higher

Were you born in Australia?YesNo

Which country were you born in?

Are you of Aboriginal or Torres Strait Islander Origin?NoTorres Strait IslanderAboriginalAboriginal & Torres Strait Islander

How well do you speak English?Very wellWellNot wellNot at all

Do you speak a language other than English at home?

Will you require additional assistance with english, maths, reading or writing?YesNo

Next of Kin name

Title

First Name

Last Name

Relationship

Next of Kin Mobile Phone

Next of Kin Home Phone

Next of Kin Work Phone

Primary Employer Details (if applicable)

Legal Business Name

Contact Name

Contact Position

Phone

Mobile

Business Address

Business Address 2

City

State

Post Code

Email

Resume upload(if available)

Craft Certificate(if available)

Certificate & Transcript 1(if available)

Certificate & Transcript 2(if available)

Terms and Conditions

I have read and agree to be bound by the terms and conditions of Australian Special Skills and Services

Unique Student IdentifierI give my consent for Australian Special Skills and Services to create a USI on my behalf; OR you have entered your USI below:

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Agency

Rep First Name

Rep Last Name

Rep Number

Rep Email

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Residential Address

Postal Address

Which Qualification(s) are you applying for?

Next of Kin name

Primary Employer Details (if applicable)

Terms and Conditions

Agents Only

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