Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
I. Course Information – Visit our website for full details (www.tpaustralia.com.au)
Course Name: RII30115 Certificate III Surface Extraction
Units included:
RIIENV201D Identify and assess environmental and heritage concerns
RIIRIS301D Apply risk management processes
RIIWHS201D Work safely and follow WHS policies and procedures
RIICOM302D Communicate workplace information
RIIGOV201D Comply with site work processes/procedures
RIISRM304D Maintain stockpiles
RIIMPO304D Conduct wheel loader operation
RIISAM202D Isolate and access plant
RIIMPO337D Conduct articulated truck operations
RIIMEX302D Assess ground conditions
RIIERR302D Respond to local emergencies and incidents
RIIMP0205D Operate roller /compactor
RIIWHS202D Enter and work in confined spaces
About the Qualification:
This qualification reflects the role of employees such as production operators in an open cut mine or quarry, who perform tasks involving a broad range of skilled applications in a varied work context, using some discretion and judgement in selecting equipment, services or contingency measures. Licensing, legislative, regulatory and certification requirements that apply to this qualification can vary between states, territories, and industry sectors. Relevant information must be sourced prior to application of the qualification.
Fees
Under the Certificate 3 Guarantee Program, the Queensland Government will subsidise the majority of the training costs. Students should expect to contribute through a student fee. These fees will subsidise the services required to provide the training and may be paid by the student, an employer or a Job Services Australia (JSA) provider.
Non Concessional $10Concession $5
Concessions to be eligible for a concession, you must hold a health care, pensioner or concession card and/or be of Aboriginal or Torres Strait Islander origin.
II. Candidate InformationSurname: Click here to enter text. Email: Click here to enter text.Given name/s: Click here to enter text. Telephone: Click here to enter text.DOB: Click here to enter text. Mobile: Click here to enter text.Gender: Click here to enter text. Work: Click here to enter text.Age at time of enrolment: Click here to enter text. Postal address: Click here to enter text.
Address:
City/ Suburb:
Postcode:
Click here to enter text. Emergency Contact:
Name:Click here to enter text.Telephone:Click here to enter text.Relationship:Click here to enter text.
Click here to enter text.
Click here to enter text.
Cultural Background:
Where you born in Australia?☐YES ☐ NOIf no, state country of birth:Click here to enter text.City of birth:Click here to enter text.
Are you of:Aboriginal origin?☐YES ☐ NO
Torres Strait Islander Origin?☐YES ☐ NO
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
Citizenship:☐ Australian Citizen☐ Australian Permanent Resident☐ Student Visa☐ Visitors Visa
☐ Holiday Visa☐ New Zealand Citizen☐ Temporary Resident Visa☐ Business Visa
III. Educational & Employment BackgroundHighest level completed at school:
☐ Yr 12 or equivalent☐ Yr 11 or equivalent☐ Yr 10 or equivalent☐ Yr 9 or equivalent☐ Yr 8 or equivalent☐ Never attended school
Which year did you complete the school level?Click here to enter text.
Are you still attending secondary school?☐YES ☐ NO
Which language do you mainly speak at home?☐ English ☐ Other: Click here to enter text.
Previous qualifications achieved
☐ Bachelor Degree ☐ Diploma☐ Certificate I☐ Certificate II
☐ Certificate III☐ Certificate IV☐ Advanced or Associate ☐ Other Diploma
Tick which boxes BEST describes your employment situation
☐ Employed full time☐ Employed part time☐ Self employed☐ Employer
☐ Unemployed – seeking fulltime employment☐ Unemployed – seeking part time employment☐ Not employed – not seeking employment
Employment Details
Employer: Click here to enter text.Branch:Click here to enter text.Telephone:Click here to enter text.
Do you give consent for a copy of your Statement of Attainment be given to your employer or other external party? ☐YES ☐ NOIf yes, please provide details (email address)Click here to enter text.
IV. Suitability assessmentTick which BEST describes your main reason for undertaking this training?
☐ To get a job☐ For personal interest☐ Self-development☐ Develop my existing business☐ Start my own business☐ A different career
☐ Better job or promotion☐ Requirement of my job☐ Extra skills for my job☐ To get into another course of study☐ Other reasons: Click here to enter text.
Disability
Do you consider yourself to have a disability, impairment or long term condition?☐ YES ☐ NO
☐ Impaired hearing☐ Physical☐ Intellectual☐ Learning Disability☐ Impaired Vision☐ Medical Condition☐ Acquired brain impairment☐ Other: Click here to enter text.
V. Enrolment InformationCourse Fee: $ Click here to enter text.
Start Date: Click here to enter a date.
Payment Methods:
☐ Cash☐ Invoice☐ Credit Card
☐ Ezypay☐ Gov Fund☐ Voucher
Delivery Method:
☐ IB = Institution Based☐ FF = Face to Face☐ FWB = Flexible Work Based☐ RPL = Recognition of Prior learning
Payments Received:
$ Click here to enter text.Duration: Click here to enter text.
Visit our website for the most current information on courses offered by TPA:
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
Course information: http://www.tpaustralia.com.au/training-courses/ Certificate 3 Guarantee: http://www.tpaustralia.com.au/certificate-3-guarantee/ Enrolment procedure: http://www.tpaustralia.com.au/training/enrollment/ Student Handbook: http://www.tpaustralia.com.au/training/enrollment/
ENROLMENT AGREEMENT
Training and Personnel Australia will provide training and assessment services outlined in the Training and Assessment Strategy and Session Plans* as negotiated with the participant/employer. Training and Personnel Australia reserves the right to negotiate with participants/employers on a case by case basis and will formalise such negotiated arrangements in writing prior to commencement.
SERVICESTraining and Personnel Australia agrees to provide the training outlined in the Training and Assessment Strategy including any arrangements pre-negotiated with the participant/employer.
The services can only be successful with full participation of the participant and (where applicable) his/her employer/supervisor. The participant acknowledges this and will make every effort reasonable and possible to complete the training.
Should Training and Personnel Australia be unable to complete its responsibilities for the delivery of training, Training and Personnel Australia will work with another provider to continue with the training.
Participants agree that if they intend to seek RPL, they will notify Training and Personnel Australia upon submission of their enrolment form and an application made as soon as practicable after enrolment. Participants further agree that, unless negotiated with Training and Personnel Australia, applications for RPL (not including evidence) will be submitted within two weeks of confirmation of enrolment being received. Where RPL forms a component of the full qualification (e.g. one or more units of competency) full qualification fees are due and payable unless prior arrangements have been made in writing between the participant and Training and Personnel Australia.
FEES, CHARGES & REFUNDSInformation on fees and charges have been read and agreed to in accordance with the Fees and Charges Schedule Training and Personnel Australia.
CANCELLATIONInformation on cancellation (including applicable refunds) is available in the Training and Personnel Australia Student Information Handbook.
AGREEMENT ACCEPTANCEThe information I have provided in this enrolment form is true and correct to the best of my knowledge. I confirm that I have read understand the Student Information Handbook and Enrolment Agreement. In signing this Agreement, I confirm that I requested enrolment in my chosen course and that Training and Personnel Australia has provided me with sufficient information on the delivery and assessment arrangements for the course. My decision to complete and submit this enrolment form has been completed without coercion.I further confirm that by signing this form, I unconditionally:1. confirm, accept and agree to bound by, the terms, covenants, and conditions stipulated in
1.1 The student training plan 1.2 Fees, Charges and Refund Policy 1.3 Student handbook
2. Acknowledge and confirm that all information relevant to my training has been provided to me 3. If paying via Direct Debit ", I agree to the total amount approved and to the repayment amount as stated in the "Direct Debit Pre
Application Form" and further more declare this arrangement will not cause me any financial hardship.
Print Name: Signature:
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
Date: Click here to enter a date.
VI. RPL Eligibility AssessmentGeneral Questions
You may leave these questions blank if:☐ Unemployed – seeking full time work☐ Unemployed – seeking part time work☐ Not employed, not seeking work
My current or most recent industry of employment is:☐ Agriculture, Forestry and Fishing☐ Mining☐ Manufacturing☐ Electricity, Gas, Water and Waste Services☐ Construction☐ Wholesale Trades☐ Accommodation and Food Services☐ Transport, Postal and Warehousing☐ Information Media and telecommunications☐ Financial and Insurance Services☐ Rental, Hiring and real estate services☐ Professional, Scientific and Technical services☐ Administrative and Support Services☐ Public Administration and Safety☐ Education and Training☐ Healthcare and social assistance☐ Arts and recreation services☐ Other: Click here to enter text.
My current or most recent occupation is:☐ Manager☐ Professional☐ Technician or Trade Worker☐ Community or personal service worker☐ Clerical or Administrative worker☐ Sales worker☐ Machinery operator or Driver☐ Labourer☐ Other: Click here to enter text.
Recognition of previous competencies
Have you completed any industry related courses in the past? ☐ YES ☐ NO
If yes, please explain what the course involved. You may be eligible for a credit transfer if you have completed any courses with the same units you are enrolling into. You will be required to supply the original or certified copies of your statement of attainment before a Credit Transfer will be granted.Click here to enter text.
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
Skills / Experience Summary
This section summarises your self-assessment of your existing skills and experiences relevant to the requirements of the units of competency included in this qualification. Please answer this section as truthfully as you can, to ensure we can provide you with the most optimal learning experience suitable to your needs and objectives.Use the following scale to rate your skill level:
0 – No prior relevant learning or work experience1 – Knowledgeable2 – Experienced 3 – Expert
In the comment section, provide details of where, how, and when you acquired your relevant knowledge, skills or experience. Provide examples where applicable. Also consider what evidence documents you will be able to provide to demonstrate your relevant skills/experience. See Appendix E for examples of evidence documents.
Skill / Experience 0 1 2 3 Comments
1) RIIENV201D (CORE)- identifying and assessing environmental and
heritage concerns in the Resources and Infrastructure Industries
☐ ☐ ☐ ☐ Click here to enter text.
2) RIIRIS301D (CORE)- applying risk management processes in the
Resources and Infrastructure Industries☐ ☐ ☐ ☐ Click here to enter text.
3) RIIWHS201D (CORE)- working safely and following WHS policies and
procedures in the Resources and Infrastructure Industries
- sourcing, interpreting, clarifying and applying site safety information
- listening carefully to health and safety instructions and information
- responding to and clarifying information and directions
- carrying out work instructions that complies with WHS policies and procedures
- selecting, wearing and caring for personal protective equipment for all activities that require personal protective equipment
- applying safe lifting and manual handling techniques
- identify and report on WHS issues to appropriate personnel
- recognising and following procedure to respond to alarms
- completing workplace reporting procedures
☐ ☐ ☐ ☐ Click here to enter text.
4) RIICOM302D (ELECTIVE)- locating, interpreting and applying relevant
operational information (research and interpretative skills)
- interpreting and applying common Industry terminology, and interpreting work procedures and processes (technical literacy and communication skills)
- obtaining information on technical working practices
☐ ☐ ☐ ☐ Click here to enter text.
5) RIIGOV201D (ELECTIVE)- Complying with site work processes/procedures
☐ ☐ ☐ ☐ Click here to enter text.
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
in the Resources and Infrastructure Industries.- planning and completing task to achieve agreed
outcomes as determined by site processes and procedures
- adjusting performance requirements to comply with processes and procedures
- monitoring and recommending changes to overcome noncompliance with site procedures/standards
- reporting noncompliance of processes and procedures to supervisors
- completing required site documents and reports6) RIISRM304D
maintaining stockpiles in the Extractive and Coal and Metalliferous mining
☐ ☐ ☐ ☐ Click here to enter text.
7) RIIMPO304D- conducting wheel loader operations in the Coal
and Metalliferous mining and Extractive☐ ☐ ☐ ☐ Click here to enter text.
8) RIISAM202D- isolating and accessing plants in Resources and
Infrastructure Industry☐ ☐ ☐ ☐ Click here to enter text.
9) RIIMPO337D- conducting articulated haul truck operations in
Civil construction, Coal and Metalliferous mining and Extractive
☐ ☐ ☐ ☐ Click here to enter text.
10) RIIMEX302D- assessing ground conditions in the Resources and
Infrastructure Industries☐ ☐ ☐ ☐ Click here to enter text.
11) RIIMP0205D - maintaining stockpiles in the Extractive and Coal
and Metalliferous mining confirming and implementing barriers and
signage carrying out inspection of the stockpiles and
surrounding areas dumping and moving stockpile materials removing and dispose of contaminants maintaining stockpile structure and battering
angle conducting basic operational maintenance
including servicing, lubrication and cleaning processing written records and reports
☐ ☐ ☐ ☐ Click here to enter text.
12) RIIERR302D- responding to local emergencies and incidents in
the Resources and Infrastructure Industries☐ ☐ ☐ ☐ Click here to enter text.
13) RIIWHS202Dentering and working in confined spaces in the Resources and Infrastructure Industries
☐ ☐ ☐ ☐ Click here to enter text.
NOTE: RPL only relates to training provided by the RTO. A full assessment is required on ALL occasions in accordance with the Assessors Guide.
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
VII. Learning StrategyLearning Style
What type of Learner are you? What type of support (if any) will assist you to complete this course?
Please tick at least one box:☐ I learn best by listening☐ I learn best by doing☐ I learn best by watching
Please tick whichever is/are applicable:☐ One on one☐ Reading and writing☐ Mathematical☐ Communication
Past learning experiencesIn my past learning, the really good things were:Click here to enter text.
In my past learning, the things I didn’t like were:Click here to enter text.
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
VIII. Literacy and Numeracy Assessment
This section will determine if you meet the minimum literacy and numeracy requirements to enter this course. This assessment covers ACSF:
Learning at level 3 Reading and writing at level 3 Numeracy at level 2
INSTRUCTIONS:Read the guide below on how to refinish woodwork. Answer the following questions based on the information provided in the article.
HIGH RISK WORK LICENSINGFOR DOGGING INFORMATION SHEET
Adapted from Safe Work Australiahttp://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/947/dogging-hrwl-
information-sheet.pdf
Is a dogger required when using a vehicle loading, bridge or gantry crane?
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
Vehicle Loading Crane and Bridge and Gantry Crane HRW licences include the application of load estimation and slinging techniques to move a load. A licensed operator of a vehicle loading, bridge or gantry crane is therefore able to make judgements on the load and slinging method and select and inspect the lifting equipment to be used for the crane they are licensed to operate.
However, the licensed operator cannot direct a vehicle loading, bridge or gantry crane operator in the movement of a load when the load is out of the crane operator’s view or operate the vehicle loading, bridge or gantry crane themselves, if the load is out of their view. In these circumstances a dogger is required to direct the crane operator.
If the load is in view of the crane operator throughout the lift and all the other conditions listed in Table 1 are met, a competent worker other than the crane operator can sling the load.
Questions 1 to 6 assess your Learning, Reading and Writing Skills against ACSF level 3. Use complete sentences where you are asked to provide a description or an explanation. A minimum score of 3/6 is required**.
1) Briefly explain what the article is about
Click here to enter text.
2) Is a dogger required in the following scenario?A mobile crane is used to lift beams to the second storey of a building under construction. The beams are dissimilar and various slinging techniques are required. The mobile crane operator cannot see the landing area for the steel beams. No safe work lifting procedures have been documented.
Click here to enter text.
3) Justify your answer in question 2.
Click here to enter text.
4) Is a dogger required in the following scenario?A factory making aluminium panels uses a bridge and gantry crane to move the panels around the workplace. The panels are always in view of the plant operator. Safe work lifting procedures have been documented and signed off by a competent person. All workers involved in the lift have been trained in the safe work lifting procedures.
Click here to enter text.
5) Justify your answer in question 4.
Click here to enter text.
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
6) In your own words, describe what a dogging is.
Click here to enter text.
Questions 7 to 10 (4 questions) assess your Numeracy Skills against ACSF level 2. A minimum score of 2/4 is required**.
7) If a harness can support a maximum weight of 2 tons, will it be able to support the weight of 5 metal beams weighing 200 kilograms each? (1 ton is equal to 907 kilograms)
Click here to enter text.
8) How much will 8 metal beams weigh?
Click here to enter text.
9) 1/3 of all the metal beams are aluminium, and 2/3 are steel. Which pie chart below shows the correct ratios for the aluminium and steel metal beams?
Aluminium Steel
☐A ☐B ☐C ☐D
10) If there were 30 beams delivered in total, how many beams are aluminium?
Click here to enter text.
**Learners who do not meet the minimum required score for this assessment may require additional support to take this course. This is in accordance with TPA’s strategies to ensure learners entering the course meet the minimum core skills
requirements to successfully complete the course and meet all its relevant learning objectives. See TPA’s Additional Support Policy for more information, or ask your enrolment adviser about it.
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
IX. Admissions Assessment (Office Use Only)NOTE TO CANDIDATE: This section of the form is to be used by TPA staff to analyse your responses in this form, and confirm that the amount of training specified in the standard session plans included in this course’s training and assessment strategy is sufficient to meet the your learning needs. Please leave this section blank.
NOTE TO ADMISSIONS OFFICER:Use this section to document your assessment of the candidate’s responses, and your corresponding recommendations.
Use the following guide questions in making your recommendations:If you answer ‘no’ in any of the questions outlined below, write relevant available support or reasonable adjustments that may be offered to the candidate to assist him/her in completing the course.
Guide Question Y/N Learning Support1) The candidate’s language, literacy and numeracy level is
sufficient to undertake this course successfully☐ Yes☐ No Click here to enter text.
2) The candidate’s relevant skills and experiences may be reviewed for assessment via the RPL pathway
Note: if you answer yes, provide details
☐ Yes☐ No Click here to enter text.
3) The standard session plan for this course is suitable to the candidate’s learning and assessment needs.
Note: if you answer no, provide details to assist the trainer/assessor in making reasonable adjustments to the candidate’s learning plan
☐ Yes☐ No
If adjusting the standard session plan, replace the session plan attached to this document as Appendix C and replace it with the adjusted session plan.Click here to enter text.
4) Candidate requires additional support?Note: if you answer yes, provide details
☐ Yes☐ No Click here to enter text.
5) Has support been requested?☐ Yes☐ No☐ N/A
Click here to enter text.
6) The student’s pre-existing skills and knowledge have been discussed
Note: provide details of discussion
☐ Yes☐ No☐ N/A
Click here to enter text.
7) Based on discussions with the student and the outcome of this assessment, does the student have the capacity and capability to complete the qualification?
Note: if you answer no, provide details
☐ Yes☐ No Click here to enter text.
DECLARATION
Following analysis of the evidence and discussion with the student:
The qualification suitable to the student’s needs: ☐ YES ☐ NO
The student is completing some units of competency via RPL: ☐ YES ☐ NO
The student has displayed characteristics that will enable him/her to achieve the qualification within the timeframe nominated:
☐ YES ☐ NO
The training and assessment strategy specifies the delivery modes and arrangements ☐ YES ☐ NO
The complexity of the qualification and existing knowledge and skills of the student are suitable for the student to complete the qualification
☐ YES ☐ NO
There is sufficient practice opportunity to enable the student to demonstrate depth and breadth of knowledge and skills in the timeframe specified
☐ YES ☐ NO
Endorsement: Proceed enrolment? ☐ YES ☐ NO
Endorsed by:DateClick here to enter a date.
Signature:
Training & Personnel AustraliaRII30115 Certificate III Surface Extraction ABN: 562 341 875 41
ACN: 160 957 979PO Box 1630, Thuringow Central, QLD
www.tpaustralia.com.au24/7 phone: 1 300 TOP JOB
Enrolment Form / RPL Eligibility & LLN Assessment Form
Version: 1.0 | Date: 4 February 2017
Student eligibility and declaration
Student Name:
Phone Number: _
Student age at time of application:
Date:
1. Eligibility (Please tick the boxes that apply to you)
Yes No☐ ☐ I do not hold a Certificate III or higher- level qualification,
as completed outside of my secondary schooling
☐ ☐ I am not currently undertaking, a Certificate III or higher- level qualification, as completed outside of my secondary schooling
☐ ☐ I am 16 years of age or older
☐ ☐ I have finished secondary school and I am no longer at school
☐ ☐ I am a Queensland resident, i.e. Australian citizen or Australian permanent resident residingin Queensland or a New Zealand citizen currently residing permanently in Queensland
2. ConcessionAre you eligible for a concession? If so, please provide ID. Please tick the box below for the ID you have provided:
☐ Health care, pensioner or concession card☐ I am of Aboriginal or Torres Strait Islander origin
In your lifetime, how many government funded courses have you commenced and not completed? Provide the total number of courses, regardless of what qualification level they are at.
0 1 2 3 4+ (Circle Number)
3. Declaration
I (Participant Name) understand that I will no longer be eligible for a subsidised training place under the Certificate 3 Guarantee Program once I have completed a Certificate III Level qualification, and it is a requirement of the program that I fill out and return a Training and Employment Survey within three (3) months of completing my qualification.
Signature
Print name
Do you have a Unique Student Identifier (USI)?
☐ Yes ☐
No If no,
☐ I authorise Training & Personnel Australia to obtain myUnique Student Identifier (USI) on my behalf
☐ I hold an official form under Commonwealth Law confirming that I am entitled to concessions under a health care concession card or pensioner concession card☐ I understand that I am only entitled to student concession rates when a Commonwealth Government agency or Employment Service is not funding my student contribution
Have you enrolled in a Certificate III with another RTO and completed any units of competency?
☐ Yes ☐ No
(If yes, please provide details including but not limited to an attached signed, certified copy of Academic Transcript or Statement of Attainment)
Identification (RTO Office use only)
Have copies of the following been collected from the student:
☐ Proof of QLD residency (drivers Licence, proof of age)
☐ Proof of Australian Citizenship or
PermanentResidency Name
Signature
Acknowledgement of Terms and Conditions
DeclarationIn making this application for enrolment, I declare that the information I have provided is true and correct. I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by Training & Personnel Australia.I also declare that I have had a Pre-Student Interview and have received a Program Outline prior to enrollment.
Program Outline (includes the following)
I have been explained how this course will be delivered including course Duration and timelines Course Organisation and Delivery Mode Pathways for students Course Requirements Student Identification requirements Fees Funding I declare that I am not currently enrolled in a certificate III or higher level qualification in any other courses
with a Register Training Organisation (RTO) I declare I do not hold a certificate III or higher level qualification I understand that access to Certificate 3 Guarantee Program funding will impact my access to government
subsided training in the future. all information provided in the enrolment documentation to be true and correct. Support Services Student Handbook – (available via the website)
Applicant Signature:
Date:
Time of signing:
If the applicant is under the age of 18 years, the enrolment application must also be signed by a relevant parent or guardian:
Parent / Guardian Name:
Parent Guardian Signature:
Date:
Time of signing:
RII30115 Certificate III Surface Extraction Enrolment Form v1.0 Page 13
No. Unit Code Unit Title
Core/
Elective
Training Delivery Details Assessment Details
Mode of delivery
Proposed Start Date
Proposed End Date
Delivery Methods
Responsibility of the
Training
Proposed Assessment
DatesAssessment methods
1
2
3
4
5
6
7
8
9
10
11
12
13
Key:
Modes of delivery Methods of Assessment:
Fact to face FFInstitution Based IBFlexible Work Based FWBRecognition of Prior learning RPLRecognition of Current Competency RCCCredit Transfer CT
1 = Observation2 = Third Party3 = Oral Questioning4 = Portfolio
5 = Workbook / Logbook6 = Written Assignment7 = Written Test
I undersigned, have discussed, understand and are satisfied with the attached Training Plan arrangements to support and deliver the required training.
Client Name:Client Signature: Date: / /
RII30115 Certificate III Surface Extraction Enrolment Form v1.0 Page 14