Student Application Form

1. STUDENT DETAILS

Title*

Mrs

Miss

Gender*

Date of Birth*

Given Name*

Surname*

Home Phone*

Mobile*

Residential Address:*

Address Suburb Post Code

Postal Address:*

Address Suburb Post Code

Email Address*

Preferred method of contact*

Phone

SMS

2. TRAINING PROGRAM DETAILS

Program Code*

Program Cost*

Program Name*

Learning Pathway*

Training and Assessment

Assessment Only

VOC

Start Date*

End Date*

Delivery Mode*

Classroom

Work Based

3. UNIQUE STUDENT IDENTIFIER (USI)

USI No*

If you do not have a USI, do you give N K Training Centre permission to apply for one on your behalf?*

Yes

To raise a USI we will need one of the following proof of Identity evidences.*

Drivers Licence No

Expiry Date

State of Issue

To raise a USI we will need one of the following proof of Identity evidences.*

Medicare Card No

Expiry Date

Ref No

Name on Card*

4. CULTURAL DIVERSITY AND CITIZENSHIP

Do you identify as a First Nations person?*

Yes - Aboriginal

Yes – Torres Strait Islander

Are you and Australian or New Zealand Citizen?*

Yes

If no, what country were you born in?

Are you visiting Australia on a Visa? (compulsory)*

Yes

If yes, what type of visa category do you hold?

5. EMPLOYMENT STATUS

What is your Employment Status?*

Full Time employee

Part time employee

Self-employed (not employing others)

Employer

Employed – unpaid worker in family business

Unemployed seeking full time work

Unemployed seeking part time work

Unemployed not seeking employment

6. LANGUAGE

Do you speak a language other than English at home?*

No – English only

Yes

Other Language

If yes, how well do you speak English?*

Very well

Well

Not well

Not at all

7. DISABILITY

Do you have a disability?*

Yes

Please state your disability, impairment or injury*

If other, please mention

8. PRIOR EDUCATION

What is your highest level of school completed?*

Year 9 or lower

Year 10

Year 11

Year 12

In which year did you complete school?*

Have you successfully completed any of the following qualifications?*

Yes

Qualifications*

Bachelor’s degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma or Associate Diploma

Certificate IV or Advance Certificate

Certificate III or Trade Certificate

Certificate II

Certificate I

Certificates - other

Do you wish to apply for Recognition of Prior Learning or Credit Transfer?*

Yes

Have you completed the Higher School Certificate (Y12 / HSC)?*

Yes

Do you consider that you have the literacy and numeracy skills to undertake the course?*

Yes

Have you completed a prior nationally recognised training in Australia at least to the level of Certificate III?*

Yes

Do you have any individual support needs that we can assist you with during your training?*

Yes

(e.g. language support needs, training needs, wellbeing needs, welfare needs, financial support needs etc)

If you answered yes to the previous question, please describe the types of support that would assist you with your studies.*

9. CORE SKILLS ASSESSMENT (INITIAL)

Writing

1. Read the paragraph below and answer the questions that follow.
In warehouses and freight terminals across NSW, forklifts are used to lift, stack and transfer loads. WorkSafe NSW has a zero-tolerance approach to the unsafe use of forklifts, considered one of the most dangerous pieces of equipment found at NSW workplaces. To be effective, a forklift must be manoeuvrable. To achieve manoeuvrability, forklifts are designed to be compact, making them less stable than other vehicles and mobile plant. Forklifts have a range of limitations, from maximum load weight to speed. These factors affect the operator and the forklift itself.

a. Why does WorkSafe NSW have a zero-tolerance approach to the unsafe use of forklifts?*

b. To be manoeuvrable a forklift has certain characteristics compared with other vehicles and plan. What are these?*

Numeracy

Reaction distance and total stopping distance
Speed (km/h)	6	12	16	18	20
Distance travelled while driver reacts and applies brakes (m)	2.5	5	6.7	7.5	8.3
Maximum stopping distance (m)	2.9-3.2	7-8	9.5-12	11-14	13-16.5

a) What is the maximum stopping distance if the forklift is travelling at 20 km/h?*

b) Even at 6km/h, a forklift driver will take _______________ metres to react and apply the brakes. He will need at least _________________ metres to stop.

Metres to react*

Metres to stop*

Digital Literacy

Can you navigate operating systems (Windows, MacOS) to access files, programs and settings?*

Yes

Can you use word processors (e.g. Microsoft Word)?*

Yes

Can you use a basic spreadsheet (e.g. Excel, Google Sheets)?*

Yes

Can you conduct basic internet browsing and online search?*

Yes

Can you send and receive emails, and open and upload attachments?*

Yes

Can you create, organise, and save files?*

Yes

Can you use video conferencing tools (e.g., Zoom, Microsoft Teams)*

Yes

Can you communicate via text message?*

Yes

10. REASON FOR STUDY

Reason For Study?*

To get a job or better job

It was a requirement of my job

To develop my existing business

To try for a different career

To start my own business

For personal interest or self-development

I want extra skills for my job

Other

11. EMERGENCY CONTACT

Name

Relationship

Home Phone

Mobile

12. MARKETING AND IMAGES

How did you hear about us?*

Existing Client

Consultant

Internet

Employer

Other

N K Training Centre may from time to time send you details about future training opportunities or offers. If you DO NOT wish to be contacted, please indicate below.*

I do not wish to be contacted regarding future training opportunities.

During training, photos or footage may be taken of you. Do you give Integral Skills permission to use these photos or footage for such things as improving training resources, promotional documents and reports?*

Yes

13. STUDENT DECLARATION

By signing this form, I certify that the information provided is true and correct. I further certify that:*

I have reviewed the Learner Handbook supplied to me and have been informed about and accept my rights and obligations.

I have reviewed and accept the Schedule of Fees and Payments and have been informed of the refund policy.

I have reviewed the Course Brochure and have been informed of and accept the training and assessment services to be provided and the units of competency to be completed.

I have reviewed the National VET Data Privacy Policy notice provided in the Learner Handbook and acknowledge that Commonwealth and State or Territory government departments and authorised agencies will use my personal information in accordance with this notice.

Signature

Date